Provider First Line Business Practice Location Address:
16980 VIA TAZON
Provider Second Line Business Practice Location Address:
160
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92127-1633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-345-4114
Provider Business Practice Location Address Fax Number:
858-679-8411
Provider Enumeration Date:
04/21/2009