Provider First Line Business Practice Location Address:
10760 EDENOAKS ST
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:
92131-3224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-880-8518
Provider Business Practice Location Address Fax Number:
858-693-1361
Provider Enumeration Date:
09/23/2011