Provider First Line Business Practice Location Address:
2780 CARDINAL ROAD
Provider Second Line Business Practice Location Address:
SUITE A
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-565-1177
Provider Business Practice Location Address Fax Number:
858-565-0696
Provider Enumeration Date:
11/07/2006