Provider First Line Business Practice Location Address:
9779 W CANYON TER
Provider Second Line Business Practice Location Address:
#1
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-4680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-569-6948
Provider Business Practice Location Address Fax Number:
858-569-6948
Provider Enumeration Date:
04/26/2010