Provider First Line Business Practice Location Address:
4241 JUTLAND DR STE 202
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:
92117-3661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-688-2090
Provider Business Practice Location Address Fax Number:
619-688-2092
Provider Enumeration Date:
09/16/2005