Provider First Line Business Practice Location Address:
11655 DUENDA RD
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:
92127-1110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-385-0223
Provider Business Practice Location Address Fax Number:
858-385-0904
Provider Enumeration Date:
12/15/2015