Provider First Line Business Practice Location Address:
10455 POMERADO RD
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:
92131-1717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-268-9054
Provider Business Practice Location Address Fax Number:
858-635-4585
Provider Enumeration Date:
05/30/2007