Provider First Line Business Practice Location Address:
12475 CAMARERO CT
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:
92130-2278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-341-5456
Provider Business Practice Location Address Fax Number:
858-558-1941
Provider Enumeration Date:
12/18/2009