Provider First Line Business Practice Location Address:
6061 BANBURY ST
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:
92139-3624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-475-2211
Provider Business Practice Location Address Fax Number:
619-479-5197
Provider Enumeration Date:
12/04/2006