Provider First Line Business Practice Location Address:
9939 HIBERT ST STE 204
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:
92131-1031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-440-7831
Provider Business Practice Location Address Fax Number:
619-440-0540
Provider Enumeration Date:
11/15/2005