Provider First Line Business Practice Location Address:
5353 MISSION CENTER RD
Provider Second Line Business Practice Location Address:
SUITE 224
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-1304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-688-5855
Provider Business Practice Location Address Fax Number:
619-291-3310
Provider Enumeration Date:
06/07/2006