Provider First Line Business Practice Location Address:
480 ALTA ROAD
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:
92198
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-279-2473
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2013