Provider First Line Business Practice Location Address:
1288 CAMINO DEL RIO N
Provider Second Line Business Practice Location Address:
T-1410
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-1511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-544-2029
Provider Business Practice Location Address Fax Number:
619-542-0292
Provider Enumeration Date:
12/03/2011