Provider First Line Business Practice Location Address:
6381 RANCHO MISSION RD
Provider Second Line Business Practice Location Address:
#2
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-2018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-283-9794
Provider Business Practice Location Address Fax Number:
619-283-2944
Provider Enumeration Date:
03/24/2008