Provider First Line Business Practice Location Address:
2270 SAN JUAN 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:
92103-1115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-501-4185
Provider Business Practice Location Address Fax Number:
619-232-7219
Provider Enumeration Date:
10/25/2005