Provider First Line Business Practice Location Address:
2401 REO DR
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:
92139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-479-6767
Provider Business Practice Location Address Fax Number:
619-434-3380
Provider Enumeration Date:
12/28/2005