Provider First Line Business Practice Location Address:
5265 AMBER VIEW PT
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:
92130-6933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-361-1390
Provider Business Practice Location Address Fax Number:
858-925-7227
Provider Enumeration Date:
07/03/2009