Provider First Line Business Practice Location Address:
6921 SPERRY CT
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:
92111-7030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-717-0164
Provider Business Practice Location Address Fax Number:
888-425-0508
Provider Enumeration Date:
07/03/2008