Provider First Line Business Practice Location Address:
3851 ROSECRANS STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92110-3134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-531-5800
Provider Business Practice Location Address Fax Number:
619-542-4186
Provider Enumeration Date:
07/24/2020