Provider First Line Business Practice Location Address:
13280 EVENING CREEK DR S
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92128-4101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-752-9735
Provider Business Practice Location Address Fax Number:
888-630-5711
Provider Enumeration Date:
07/19/2006