Provider First Line Business Practice Location Address:
6070 MISSION GORGE RD
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:
92120-4023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-909-9169
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/14/2010