Provider First Line Business Practice Location Address:
8933 ACTIVITY RD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-653-6130
Provider Business Practice Location Address Fax Number:
858-653-6125
Provider Enumeration Date:
06/15/2007