Provider First Line Business Practice Location Address:
5920 FRIARS ROAD
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:
92108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-260-0750
Provider Business Practice Location Address Fax Number:
619-260-0201
Provider Enumeration Date:
04/20/2007