Provider First Line Business Practice Location Address:
12886 SEABREEZE FARMS 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:
92130-3735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-259-6825
Provider Business Practice Location Address Fax Number:
858-259-6825
Provider Enumeration Date:
09/21/2009