Provider First Line Business Practice Location Address:
4313 RIDGEWAY DR
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:
92116-2052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-501-0334
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2008