Provider First Line Business Practice Location Address:
4550 KEARNY VILLA RD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-354-6276
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2006