Provider First Line Business Practice Location Address:
6534 DWANE AVE
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:
92120-3927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-455-7040
Provider Business Practice Location Address Fax Number:
619-462-7049
Provider Enumeration Date:
02/01/2007