Provider First Line Business Practice Location Address:
11512 EL CAMINO REAL
Provider Second Line Business Practice Location Address:
350
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92130-2087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-340-1560
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/25/2014