Provider First Line Business Practice Location Address:
10675 TREENA ST
Provider Second Line Business Practice Location Address:
102
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92131-2478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-578-9923
Provider Business Practice Location Address Fax Number:
858-566-0059
Provider Enumeration Date:
04/28/2006