Provider First Line Business Practice Location Address:
3944 SAN AUGUSTINE WAY
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:
92130-2260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-793-4496
Provider Business Practice Location Address Fax Number:
858-793-5461
Provider Enumeration Date:
10/25/2011