Provider First Line Business Practice Location Address:
4605 MORENA BLVD
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:
92117-3650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-581-4550
Provider Business Practice Location Address Fax Number:
858-581-4424
Provider Enumeration Date:
03/17/2009