Provider First Line Business Practice Location Address:
5471 KEARNY VILLA RD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-1151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-597-2275
Provider Business Practice Location Address Fax Number:
858-597-0252
Provider Enumeration Date:
05/11/2006