Provider First Line Business Practice Location Address:
5755 OBERLIN DR
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-1786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-225-2220
Provider Business Practice Location Address Fax Number:
619-225-1126
Provider Enumeration Date:
01/30/2007