Provider First Line Business Practice Location Address:
10948 DEERING ST
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:
92126-2120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-695-3487
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/02/2007