Provider First Line Business Practice Location Address:
7920 FROST STREET
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:
92123-4223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-966-7484
Provider Business Practice Location Address Fax Number:
858-966-4064
Provider Enumeration Date:
03/06/2008