Provider First Line Business Practice Location Address:
1202 MORENA BLVD STE 100
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:
92110-3842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-275-0822
Provider Business Practice Location Address Fax Number:
619-275-1422
Provider Enumeration Date:
10/26/2022