Provider First Line Business Practice Location Address:
8170 MIRAMAR 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:
92126-4321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-630-5442
Provider Business Practice Location Address Fax Number:
858-552-0910
Provider Enumeration Date:
06/27/2013