Provider First Line Business Practice Location Address:
6325 DENNISON ST
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:
92122-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-583-6431
Provider Business Practice Location Address Fax Number:
858-587-2802
Provider Enumeration Date:
07/03/2014