Provider First Line Business Practice Location Address:
9450 SCRANTON RD
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-4720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-457-5801
Provider Business Practice Location Address Fax Number:
858-457-8514
Provider Enumeration Date:
08/15/2014