Provider First Line Business Practice Location Address:
10706 MARBURY 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:
92126-2839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-361-1341
Provider Business Practice Location Address Fax Number:
619-374-2984
Provider Enumeration Date:
03/21/2007