Provider First Line Business Practice Location Address:
4240 KEARNY MESA RD.
Provider Second Line Business Practice Location Address:
SUITE #117
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-499-8911
Provider Business Practice Location Address Fax Number:
858-499-8913
Provider Enumeration Date:
10/02/2006