Provider First Line Business Practice Location Address:
10415 SAN DIEGO MISSION RD STE C
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:
92108-2183
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-280-0554
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2007