Provider First Line Business Practice Location Address:
8312 LAKE MURRAY BLVD
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92119-3435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-461-5422
Provider Business Practice Location Address Fax Number:
619-461-5424
Provider Enumeration Date:
03/10/2007