Provider First Line Business Practice Location Address:
3453 AVELEY PL
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:
92111-4727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-541-2632
Provider Business Practice Location Address Fax Number:
858-541-2663
Provider Enumeration Date:
11/30/2009