Provider First Line Business Practice Location Address:
7485 MISSION VALLEY RD
Provider Second Line Business Practice Location Address:
SUITE 104 A
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-4422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-291-8930
Provider Business Practice Location Address Fax Number:
619-398-4989
Provider Enumeration Date:
01/15/2008