Provider First Line Business Practice Location Address:
5610 KEARNY MESA 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:
92111-1313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-699-3104
Provider Business Practice Location Address Fax Number:
858-569-0660
Provider Enumeration Date:
12/02/2012