Provider First Line Business Practice Location Address:
7155 MISSION GORGE 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:
92120-1130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-350-3737
Provider Business Practice Location Address Fax Number:
858-810-0174
Provider Enumeration Date:
08/20/2006