Provider First Line Business Practice Location Address:
2930 TARAWA 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:
92155-5198
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-437-5962
Provider Business Practice Location Address Fax Number:
619-437-2074
Provider Enumeration Date:
04/20/2006