Provider First Line Business Practice Location Address:
5288 EASTGATE MALL
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:
92121-2835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-622-0792
Provider Business Practice Location Address Fax Number:
858-866-0760
Provider Enumeration Date:
09/16/2006