Provider First Line Business Practice Location Address:
3754 CLAIREMONT DR
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:
92117-5916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-276-6912
Provider Business Practice Location Address Fax Number:
858-483-3567
Provider Enumeration Date:
06/18/2007