Provider First Line Business Practice Location Address:
6160 MISSION GORGE RD
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92120-3410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-412-4191
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2006