Provider First Line Business Practice Location Address:
2496 BAUER 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:
92145-2051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-577-9619
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/01/2011