Provider First Line Business Practice Location Address:
9883 PACIFIC HEIGHTS BLVD STE B
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:
92121-4709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-450-6675
Provider Business Practice Location Address Fax Number:
858-450-6673
Provider Enumeration Date:
12/06/2007