Provider First Line Business Practice Location Address:
5471 KEARNY VILLA RD.
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-1143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-571-0606
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/21/2011