Provider First Line Business Practice Location Address:
5752 OBERLIN DR STE 203
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:
92121-1749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-699-1497
Provider Business Practice Location Address Fax Number:
858-481-8271
Provider Enumeration Date:
09/21/2006