Provider First Line Business Practice Location Address:
10883 CREEKBRIDGE 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:
92128-5108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-603-5646
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2013