Provider First Line Business Practice Location Address:
12786 SALMON RIVER RD
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:
92129-3553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-953-6880
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/07/2014