Provider First Line Business Practice Location Address:
13248 POWAY ROAD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
POWAY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-391-1372
Provider Business Practice Location Address Fax Number:
858-391-9030
Provider Enumeration Date:
10/02/2006