Provider First Line Business Practice Location Address:
2496 BAUER RD
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:
92145-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-577-6252
Provider Business Practice Location Address Fax Number:
858-577-7754
Provider Enumeration Date:
06/29/2006