Provider First Line Business Practice Location Address:
3685 KEARNY VILLA 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:
92123-1950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-966-7453
Provider Business Practice Location Address Fax Number:
858-966-8011
Provider Enumeration Date:
04/21/2015