Provider First Line Business Practice Location Address:
220 HIGHLAND DRIVE
Provider Second Line Business Practice Location Address:
SUITE # 105
Provider Business Practice Location Address City Name:
SOLANO BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-291-7100
Provider Business Practice Location Address Fax Number:
619-291-3040
Provider Enumeration Date:
10/23/2006