Provider First Line Business Practice Location Address:
3689 MIDWAY DR.
Provider Second Line Business Practice Location Address:
STE. D
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-523-9990
Provider Business Practice Location Address Fax Number:
619-523-2176
Provider Enumeration Date:
12/08/2006