Provider First Line Business Practice Location Address:
4709 MOUNT ABERNATHY AVE
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:
92117-3340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-444-7904
Provider Business Practice Location Address Fax Number:
858-278-2093
Provider Enumeration Date:
11/22/2010