Provider First Line Business Practice Location Address:
9484 BLACK MOUNTAIN RD
Provider Second Line Business Practice Location Address:
SUITE I
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92126-4520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-566-2446
Provider Business Practice Location Address Fax Number:
858-566-2448
Provider Enumeration Date:
08/12/2006