Provider First Line Business Practice Location Address:
8940 ACTIVITY RD STE K
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:
92126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-571-6544
Provider Business Practice Location Address Fax Number:
858-292-1913
Provider Enumeration Date:
05/21/2008