Provider First Line Business Practice Location Address:
7290 NAVAJO RD STE 105
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:
92119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-733-6472
Provider Business Practice Location Address Fax Number:
619-448-0132
Provider Enumeration Date:
07/13/2006