Provider First Line Business Practice Location Address:
4550 KEARNY VILLA RD
Provider Second Line Business Practice Location Address:
SUITE 116
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-1578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-279-1223
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2006