Provider First Line Business Practice Location Address:
12285 SCRIPPS POWAY PKWY
Provider Second Line Business Practice Location Address:
#104
Provider Business Practice Location Address City Name:
POWAY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92064-6149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-536-8111
Provider Business Practice Location Address Fax Number:
858-547-4193
Provider Enumeration Date:
07/13/2006