Provider First Line Business Practice Location Address:
4165 VIA CANDIDIZ UNIT 30
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:
92130-2189
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-481-2535
Provider Business Practice Location Address Fax Number:
858-481-2532
Provider Enumeration Date:
05/19/2009