Provider First Line Business Practice Location Address:
4926 LA CUENTA DR STE 200
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:
92124-2608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-342-2891
Provider Business Practice Location Address Fax Number:
619-229-0501
Provider Enumeration Date:
01/04/2007