Provider First Line Business Practice Location Address:
3549 CAMINO DEL RIO S
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-4023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-543-0144
Provider Business Practice Location Address Fax Number:
619-543-0445
Provider Enumeration Date:
06/25/2006