Provider First Line Business Practice Location Address:
11730 CAMINITO PRENTICIA
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:
92131-2102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-695-3849
Provider Business Practice Location Address Fax Number:
858-635-2101
Provider Enumeration Date:
02/15/2006