Provider First Line Business Practice Location Address:
11125 FLINTKOTE AVE STE F
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:
92121-1213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-622-1278
Provider Business Practice Location Address Fax Number:
858-622-1283
Provider Enumeration Date:
12/03/2008