Provider First Line Business Practice Location Address:
4626 MERCURY ST
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:
92111-2410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-292-8180
Provider Business Practice Location Address Fax Number:
858-292-0690
Provider Enumeration Date:
12/21/2007