Provider First Line Business Practice Location Address:
5181 ABUELA DR
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:
92124-2020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-279-5124
Provider Business Practice Location Address Fax Number:
800-856-1193
Provider Enumeration Date:
08/08/2011