Provider First Line Business Practice Location Address:
5995 MISSION GORGE RD
Provider Second Line Business Practice Location Address:
B
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92120-4028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-322-8551
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2011