Provider First Line Business Practice Location Address:
6280 JACKSON DR
Provider Second Line Business Practice Location Address:
STE 7
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92119-3437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-697-0944
Provider Business Practice Location Address Fax Number:
619-697-5924
Provider Enumeration Date:
03/27/2007