Provider First Line Business Practice Location Address:
10415 SAN DIEGO MISSION RD STE A
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:
92108-2183
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-640-3000
Provider Business Practice Location Address Fax Number:
619-640-3020
Provider Enumeration Date:
03/28/2007