Provider First Line Business Practice Location Address:
7445 MISSION VALLEY RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-4408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-574-6909
Provider Business Practice Location Address Fax Number:
619-574-1639
Provider Enumeration Date:
07/15/2008