Provider First Line Business Practice Location Address:
5989 COZZENS 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:
92122-3724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-945-0716
Provider Business Practice Location Address Fax Number:
858-939-6725
Provider Enumeration Date:
10/06/2011