Provider First Line Business Practice Location Address:
16431 AMBROSE LN
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:
92127-4404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-357-1140
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2016