Provider First Line Business Practice Location Address:
8716 PRODUCTION 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:
92121-2297
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-699-0722
Provider Business Practice Location Address Fax Number:
858-271-0051
Provider Enumeration Date:
03/07/2011