Provider First Line Business Practice Location Address:
13352 THUNDERHEAD ST
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:
92129-2330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-610-7149
Provider Business Practice Location Address Fax Number:
858-206-5241
Provider Enumeration Date:
03/27/2013