Provider First Line Business Practice Location Address:
10801 THORNMINT RD
Provider Second Line Business Practice Location Address:
250
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92127-1080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-521-3325
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2014