Provider First Line Business Practice Location Address:
11945 HANDRICH DR
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:
92131-1411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-747-6988
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2008