Provider First Line Business Practice Location Address:
17180 PATINA ST
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:
92127-5700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-674-5701
Provider Business Practice Location Address Fax Number:
619-659-5738
Provider Enumeration Date:
04/06/2007