Provider First Line Business Practice Location Address:
11110 RED CEDAR DR
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:
92131-1310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-689-9770
Provider Business Practice Location Address Fax Number:
619-337-1499
Provider Enumeration Date:
02/11/2007