Provider First Line Business Practice Location Address:
6336 COLLEGE GROVE WAY
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:
92115-7244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-858-0097
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2006