Provider First Line Business Practice Location Address:
10393 SAN DIEGO MISSION RD
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-2175
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-280-0554
Provider Business Practice Location Address Fax Number:
619-280-2099
Provider Enumeration Date:
06/13/2007