Provider First Line Business Practice Location Address:
9520 PADGETT ST
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92126-4445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-866-8133
Provider Business Practice Location Address Fax Number:
858-999-2002
Provider Enumeration Date:
08/31/2007