Provider First Line Business Practice Location Address:
7330 ENGINEER RD
Provider Second Line Business Practice Location Address:
UNIT B
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92111-1434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-300-4784
Provider Business Practice Location Address Fax Number:
858-300-2657
Provider Enumeration Date:
01/31/2014