Provider First Line Business Practice Location Address:
4316 CORTE DE LA FONDA
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:
92130-2126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-741-3502
Provider Business Practice Location Address Fax Number:
888-678-3543
Provider Enumeration Date:
04/03/2007