Provider First Line Business Practice Location Address:
5425 OBERLIN DR STE 105
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:
92121-1703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-846-0361
Provider Business Practice Location Address Fax Number:
858-521-9344
Provider Enumeration Date:
10/31/2007