Provider First Line Business Practice Location Address:
14070 COLLINS RANCH PL
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:
92130-5572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-240-7164
Provider Business Practice Location Address Fax Number:
858-240-7164
Provider Enumeration Date:
01/17/2010