Provider First Line Business Practice Location Address:
6939 TERRA COTTA RD
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:
92114-7919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-434-7582
Provider Business Practice Location Address Fax Number:
619-434-7582
Provider Enumeration Date:
06/09/2010