Provider First Line Business Practice Location Address:
3525 DEL MAR HEIGHTS RD # 109
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:
92130-2199
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-245-6333
Provider Business Practice Location Address Fax Number:
858-925-1056
Provider Enumeration Date:
09/30/2006