Provider First Line Business Practice Location Address:
12625 HIGH BLUFF DR STE 107
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:
92130-2053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-373-6429
Provider Business Practice Location Address Fax Number:
626-380-4359
Provider Enumeration Date:
01/10/2011