Provider First Line Business Practice Location Address:
7850 VISTA HILL AVE
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:
92123-2717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-294-4119
Provider Business Practice Location Address Fax Number:
619-295-5044
Provider Enumeration Date:
10/02/2006