Provider First Line Business Practice Location Address:
5995 MISSION GORGE RD
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92120-4028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-716-7466
Provider Business Practice Location Address Fax Number:
619-282-4394
Provider Enumeration Date:
08/24/2006