Provider First Line Business Practice Location Address:
7944 BIRMINGHAM DR
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:
92123-2705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-939-4622
Provider Business Practice Location Address Fax Number:
858-939-4627
Provider Enumeration Date:
03/13/2007