Provider First Line Business Practice Location Address:
4302 MOUNT HUKEE 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:
92117-4736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-922-6440
Provider Business Practice Location Address Fax Number:
858-268-3664
Provider Enumeration Date:
11/21/2005