Provider First Line Business Practice Location Address:
10896 POBLADO RD
Provider Second Line Business Practice Location Address:
1322
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92127-5325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-877-0647
Provider Business Practice Location Address Fax Number:
858-705-6108
Provider Enumeration Date:
10/20/2012