Provider First Line Business Practice Location Address:
7216 BROOKHAVEN RD
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:
92114-7112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-470-4697
Provider Business Practice Location Address Fax Number:
619-470-4697
Provider Enumeration Date:
02/28/2008