Provider First Line Business Practice Location Address:
5995 MISSION GORGE RD
Provider Second Line Business Practice Location Address:
STE A
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-280-6500
Provider Business Practice Location Address Fax Number:
619-282-4394
Provider Enumeration Date:
10/02/2006