Provider First Line Business Practice Location Address:
12798 RANCHO PENASQUITOS BL
Provider Second Line Business Practice Location Address:
STE.J
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-484-4242
Provider Business Practice Location Address Fax Number:
858-484-4002
Provider Enumeration Date:
12/04/2006