Provider First Line Business Practice Location Address:
2968 LANING 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:
92106-6434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-743-2102
Provider Business Practice Location Address Fax Number:
760-269-7427
Provider Enumeration Date:
05/30/2007