Provider First Line Business Practice Location Address:
4171 LAS PALMAS SQUARE
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:
91945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-646-3415
Provider Business Practice Location Address Fax Number:
858-677-9818
Provider Enumeration Date:
04/09/2007