Provider First Line Business Practice Location Address:
6154 MISSION GORGE RD STE 120
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:
92120-3435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-285-1718
Provider Business Practice Location Address Fax Number:
619-285-3803
Provider Enumeration Date:
09/10/2009