Provider First Line Business Practice Location Address:
12356 AVENIDA CONSENTIDO
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:
92128-3283
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-485-0599
Provider Business Practice Location Address Fax Number:
858-485-0599
Provider Enumeration Date:
10/24/2013