Provider First Line Business Practice Location Address:
7183 NAVAJO RD STE I
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:
92119-1650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-550-7447
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2012