Provider First Line Business Practice Location Address:
2940 MAKAHA WAY
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:
92154-1556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-650-8814
Provider Business Practice Location Address Fax Number:
208-504-1865
Provider Enumeration Date:
07/28/2014