Provider First Line Business Practice Location Address:
9540 WAPLES ST STE A
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:
92121-2970
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-490-4281
Provider Business Practice Location Address Fax Number:
858-299-5227
Provider Enumeration Date:
03/30/2007