Provider First Line Business Practice Location Address:
5610 KEARNY MESA RD STE A
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:
92111-1313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-259-6115
Provider Business Practice Location Address Fax Number:
858-259-0013
Provider Enumeration Date:
02/21/2014