Provider First Line Business Practice Location Address:
11650 IBERIA PL STE 135
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:
92128-2456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-442-9170
Provider Business Practice Location Address Fax Number:
310-388-4948
Provider Enumeration Date:
01/31/2006