Provider First Line Business Practice Location Address:
11650 IBERIA PL
Provider Second Line Business Practice Location Address:
101
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92128-2406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-485-8558
Provider Business Practice Location Address Fax Number:
858-485-0461
Provider Enumeration Date:
02/05/2007