Provider First Line Business Practice Location Address:
710 DENNERY 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:
92154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-428-4088
Provider Business Practice Location Address Fax Number:
619-428-4063
Provider Enumeration Date:
07/25/2014