Provider First Line Business Practice Location Address:
5959 MISSION GORGE RD STE 106
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:
92120-4019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-260-1357
Provider Business Practice Location Address Fax Number:
619-238-1460
Provider Enumeration Date:
04/30/2010