Provider First Line Business Practice Location Address:
11428 ALBORADA DR
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:
92127-3125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-521-8885
Provider Business Practice Location Address Fax Number:
858-430-3166
Provider Enumeration Date:
08/26/2011