Provider First Line Business Practice Location Address:
6540 LUSK BLVD
Provider Second Line Business Practice Location Address:
#C256
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-2767
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-492-8511
Provider Business Practice Location Address Fax Number:
858-657-0251
Provider Enumeration Date:
04/13/2009