Provider First Line Business Practice Location Address:
10992 SAN DIEGO MISSION RD
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-2444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-641-4663
Provider Business Practice Location Address Fax Number:
619-641-4111
Provider Enumeration Date:
01/23/2007