Provider First Line Business Practice Location Address:
7750 DAGGET ST
Provider Second Line Business Practice Location Address:
102
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92111-2234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-569-4588
Provider Business Practice Location Address Fax Number:
858-569-4188
Provider Enumeration Date:
05/03/2007