Provider First Line Business Practice Location Address:
10065 OLD GROVE RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92131-1664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-527-1860
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2009