Provider First Line Business Practice Location Address:
4540 KEARNY VILLA RD
Provider Second Line Business Practice Location Address:
#117
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-1571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-565-1167
Provider Business Practice Location Address Fax Number:
619-284-5605
Provider Enumeration Date:
12/05/2006