Provider First Line Business Practice Location Address:
5677 OBERLIN DR
Provider Second Line Business Practice Location Address:
ST 106
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-1740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-457-8419
Provider Business Practice Location Address Fax Number:
858-457-0670
Provider Enumeration Date:
07/11/2014