Provider First Line Business Practice Location Address:
12422 SALMON RIVER RD
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:
92129-3545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-753-8090
Provider Business Practice Location Address Fax Number:
858-244-7910
Provider Enumeration Date:
08/18/2006