Provider First Line Business Practice Location Address:
820 BRIGHTON CT
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:
92109-8228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-488-9750
Provider Business Practice Location Address Fax Number:
858-488-9750
Provider Enumeration Date:
02/02/2007