Provider First Line Business Practice Location Address:
6529 MISSION GORGE 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:
92120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-283-3161
Provider Business Practice Location Address Fax Number:
619-280-8378
Provider Enumeration Date:
12/18/2006