Provider First Line Business Practice Location Address:
4747 MISSION BLVD STE 4A
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:
92109-2541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-220-8213
Provider Business Practice Location Address Fax Number:
858-581-6999
Provider Enumeration Date:
05/02/2013