Provider First Line Business Practice Location Address:
5317 CALLE VIS
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:
92109-1920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-298-3251
Provider Business Practice Location Address Fax Number:
858-488-8839
Provider Enumeration Date:
07/10/2006