Provider First Line Business Practice Location Address:
11483 NANTUCKET PKWY
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:
92130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-457-2848
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/31/2006