Provider First Line Business Practice Location Address:
13506 GINGER GLEN RD
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:
92130-6913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-699-3149
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/29/2012