Provider First Line Business Practice Location Address:
8686 CAPRICORN 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:
92126-1851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-695-9535
Provider Business Practice Location Address Fax Number:
858-549-7057
Provider Enumeration Date:
01/30/2007