Provider First Line Business Practice Location Address:
5959 MISSION GORGE RD
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92120-4017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-283-1116
Provider Business Practice Location Address Fax Number:
619-283-1131
Provider Enumeration Date:
11/08/2006