Provider First Line Business Practice Location Address:
11241 SPENCERPORT WAY
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:
92131-2912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-549-9652
Provider Business Practice Location Address Fax Number:
858-549-4941
Provider Enumeration Date:
07/13/2006