Provider First Line Business Practice Location Address:
8755 PROMENADE NORTH PL
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:
92123-6453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-846-3649
Provider Business Practice Location Address Fax Number:
858-571-0098
Provider Enumeration Date:
12/15/2011