Provider First Line Business Practice Location Address:
3630 ENTERPRISE ST
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:
92110-3212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-299-0840
Provider Business Practice Location Address Fax Number:
619-291-5098
Provider Enumeration Date:
07/07/2005