Provider First Line Business Practice Location Address:
10353 SAN DIEGO MISSION RD
Provider Second Line Business Practice Location Address:
APT C219
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-2136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-886-1454
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/31/2006