Provider First Line Business Practice Location Address:
6540 LUSK BLVD
Provider Second Line Business Practice Location Address:
SUITE C239
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-2767
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-733-7632
Provider Business Practice Location Address Fax Number:
619-733-7632
Provider Enumeration Date:
09/22/2008