Provider First Line Business Practice Location Address:
10755 SCRIPPS POWAY PARKWAY #K
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
92131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-547-0070
Provider Business Practice Location Address Fax Number:
858-635-3125
Provider Enumeration Date:
08/03/2006