Provider First Line Business Practice Location Address:
7155 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:
92120-1130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-300-0460
Provider Business Practice Location Address Fax Number:
858-300-0461
Provider Enumeration Date:
02/13/2007