Provider First Line Business Practice Location Address:
5375 KEARNY VILLA RD.
Provider Second Line Business Practice Location Address:
SUITE # 103
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-1422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-277-5737
Provider Business Practice Location Address Fax Number:
858-277-5773
Provider Enumeration Date:
04/26/2007