Provider First Line Business Practice Location Address:
9939 HIBERT ST
Provider Second Line Business Practice Location Address:
STE. 108
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92131-1029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-733-3655
Provider Business Practice Location Address Fax Number:
858-578-3800
Provider Enumeration Date:
11/26/2006