Provider First Line Business Practice Location Address:
5638 MISSION CENTER RD
Provider Second Line Business Practice Location Address:
#104
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-4348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-293-7164
Provider Business Practice Location Address Fax Number:
619-293-0708
Provider Enumeration Date:
11/27/2006