Provider First Line Business Practice Location Address:
4015 GOVERNOR DR
Provider Second Line Business Practice Location Address:
MIRACLE-EAR CENTER
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92122-2522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-458-9019
Provider Business Practice Location Address Fax Number:
858-458-9268
Provider Enumeration Date:
01/25/2007