Provider First Line Business Practice Location Address:
4170 NORMAN SCOTT 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:
92136-5501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-767-6577
Provider Business Practice Location Address Fax Number:
619-767-6605
Provider Enumeration Date:
01/03/2007