Provider First Line Business Practice Location Address:
2831 CAMINO DEL RIO S
Provider Second Line Business Practice Location Address:
211
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-3802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-940-0880
Provider Business Practice Location Address Fax Number:
760-930-9157
Provider Enumeration Date:
01/16/2007