Provider First Line Business Practice Location Address:
3670 CLAIREMONT DR
Provider Second Line Business Practice Location Address:
#7
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-581-0664
Provider Business Practice Location Address Fax Number:
858-362-1231
Provider Enumeration Date:
07/31/2006