Provider First Line Business Practice Location Address:
5950 SANTO ROAD
Provider Second Line Business Practice Location Address:
SUITE D
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-715-3878
Provider Business Practice Location Address Fax Number:
858-715-3879
Provider Enumeration Date:
08/16/2006