Provider First Line Business Practice Location Address:
9840 APPLE TREE DR UNIT D
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:
92124-1602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-921-7810
Provider Business Practice Location Address Fax Number:
858-384-7203
Provider Enumeration Date:
09/01/2009