Provider First Line Business Practice Location Address:
4141 PACIFIC HWY
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:
92110-2030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-628-4696
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2024