Provider First Line Business Practice Location Address:
140 SYLVESTER RD BLDG 212
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:
92106-3521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-553-0367
Provider Business Practice Location Address Fax Number:
619-553-7506
Provider Enumeration Date:
09/29/2011