Provider First Line Business Practice Location Address:
3065 CLAIREMONT DR STE C
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:
92117-6974
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-275-2626
Provider Business Practice Location Address Fax Number:
619-275-5937
Provider Enumeration Date:
03/06/2007