Provider First Line Business Practice Location Address:
10174 OLD GROVE RD STE 100
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:
92131-1652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-876-9945
Provider Business Practice Location Address Fax Number:
619-281-3714
Provider Enumeration Date:
11/28/2007