Provider First Line Business Practice Location Address:
7950 SILVERTON AVE
Provider Second Line Business Practice Location Address:
SUITE 114
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92126-6342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-530-0442
Provider Business Practice Location Address Fax Number:
858-530-0545
Provider Enumeration Date:
01/12/2009