Provider First Line Business Practice Location Address:
7192 WHIPPLE AVE
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:
92122-2838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-752-4499
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2006