Provider First Line Business Practice Location Address:
2168 HARBOUR HEIGHTS RD
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:
92109-1427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-997-7895
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/14/2014