Provider First Line Business Practice Location Address:
4683 MERCURY ST
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92111-2423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-467-9893
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/07/2009