Provider First Line Business Practice Location Address:
408 ALTA RD
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:
92158-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-661-6500
Provider Business Practice Location Address Fax Number:
619-671-7588
Provider Enumeration Date:
03/05/2012