Provider First Line Business Practice Location Address:
5677 OBERLIN DR STE 112
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:
92121-1741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-303-7400
Provider Business Practice Location Address Fax Number:
619-460-6316
Provider Enumeration Date:
05/07/2007