Provider First Line Business Practice Location Address:
12798 RANCH PENASQUITOS BLVD
Provider Second Line Business Practice Location Address:
SUITE I
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-484-9776
Provider Business Practice Location Address Fax Number:
858-484-0721
Provider Enumeration Date:
08/24/2006