Provider First Line Business Practice Location Address:
7525 LINDA VISTA RD STE C
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:
92111-5344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-398-2988
Provider Business Practice Location Address Fax Number:
619-398-2987
Provider Enumeration Date:
06/27/2006