Provider First Line Business Practice Location Address:
6371 RANCHO MISSION RD
Provider Second Line Business Practice Location Address:
UNIT 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:
92108-2016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-988-2210
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2007