Provider First Line Business Practice Location Address:
13176 CALLE DE LOS NINOS
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:
92129-2919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-421-4257
Provider Business Practice Location Address Fax Number:
619-421-6913
Provider Enumeration Date:
05/11/2007