Provider First Line Business Practice Location Address:
4926 LA CUENTA DR
Provider Second Line Business Practice Location Address:
SUITE 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:
92124-2609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-292-0492
Provider Business Practice Location Address Fax Number:
619-296-2130
Provider Enumeration Date:
10/31/2005