Provider First Line Business Practice Location Address:
6061 MISSION GORGE RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92120-4007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-281-3706
Provider Business Practice Location Address Fax Number:
619-281-3714
Provider Enumeration Date:
11/02/2006