Provider First Line Business Practice Location Address:
11239A CAMINO RUIZ
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:
92126-4601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-653-5916
Provider Business Practice Location Address Fax Number:
858-653-5295
Provider Enumeration Date:
10/10/2006