Provider First Line Business Practice Location Address:
9855 ERMA ROAD
Provider Second Line Business Practice Location Address:
SUITE 138
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-549-9688
Provider Business Practice Location Address Fax Number:
858-549-7103
Provider Enumeration Date:
11/09/2006