Provider First Line Business Practice Location Address:
13330 VIA MILAZZO UNIT 2
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:
92129-5144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-243-3405
Provider Business Practice Location Address Fax Number:
619-740-4415
Provider Enumeration Date:
02/20/2007