Provider First Line Business Practice Location Address:
8226 MIRAMAR RD
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:
92126-4345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-689-6088
Provider Business Practice Location Address Fax Number:
858-689-6086
Provider Enumeration Date:
11/16/2006