Provider First Line Business Practice Location Address:
8503 SUMMERDALE RD
Provider Second Line Business Practice Location Address:
376
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92126-5424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-302-4163
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2013