Provider First Line Business Practice Location Address:
6824 PANAMINT ROW UNIT 3
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:
92139-2815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-267-7760
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/24/2008