Provider First Line Business Practice Location Address:
12356 CAMINITO GRANATE
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:
92130-2848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-342-1133
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/04/2017