Provider First Line Business Practice Location Address:
4985 PARK RIM DR
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:
92117-1721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-272-9812
Provider Business Practice Location Address Fax Number:
858-272-9812
Provider Enumeration Date:
09/12/2005