Provider First Line Business Practice Location Address:
4660 VIEWRIDGE AVE
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:
92123-1638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-292-1055
Provider Business Practice Location Address Fax Number:
858-292-0669
Provider Enumeration Date:
02/07/2007