Provider First Line Business Practice Location Address:
10981 SAN DIEGO MISSION RD
Provider Second Line Business Practice Location Address:
SUITE 114
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-2448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-286-2687
Provider Business Practice Location Address Fax Number:
619-286-2687
Provider Enumeration Date:
07/10/2006