Provider First Line Business Practice Location Address:
35000 GUADALCANAL ST
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:
92140-1407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-524-4053
Provider Business Practice Location Address Fax Number:
619-524-0852
Provider Enumeration Date:
07/12/2012