Provider First Line Business Practice Location Address:
1127 MANZANA WAY
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:
92139-1438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-253-6514
Provider Business Practice Location Address Fax Number:
619-568-3585
Provider Enumeration Date:
04/28/2009