Provider First Line Business Practice Location Address:
4660 PALM AVE BLDG A
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:
92154-8404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-662-5383
Provider Business Practice Location Address Fax Number:
619-662-5375
Provider Enumeration Date:
07/03/2007