Provider First Line Business Practice Location Address:
3160 W CANYON AVE
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:
92123-5428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-583-0924
Provider Business Practice Location Address Fax Number:
844-352-6658
Provider Enumeration Date:
03/05/2007