Provider First Line Business Practice Location Address:
6136 MISSION GORGE RD
Provider Second Line Business Practice Location Address:
SUITE 129
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92120-3494
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-282-4270
Provider Business Practice Location Address Fax Number:
619-282-4272
Provider Enumeration Date:
08/09/2010