Provider First Line Business Practice Location Address:
7488 CALZADA DE LA FUENTE
Provider Second Line Business Practice Location Address:
MEDICAL
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92154-2717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-661-4064
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2006