Provider First Line Business Practice Location Address:
6640 LUSK BLVD
Provider Second Line Business Practice Location Address:
SUITE A207
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-2784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-246-7767
Provider Business Practice Location Address Fax Number:
858-246-7768
Provider Enumeration Date:
02/02/2010