Provider First Line Business Practice Location Address:
16885 W BERNARDO DR
Provider Second Line Business Practice Location Address:
SUITE 235
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92127-1618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-550-3201
Provider Business Practice Location Address Fax Number:
619-342-7527
Provider Enumeration Date:
11/02/2007