Provider First Line Business Practice Location Address:
4550 KEARNY VILLA RD STE 107
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:
92123-1558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-249-7660
Provider Business Practice Location Address Fax Number:
619-574-0181
Provider Enumeration Date:
11/09/2006