Provider First Line Business Practice Location Address:
7424 JACKSON DR STE 3
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:
92119-2324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-460-4600
Provider Business Practice Location Address Fax Number:
619-460-6814
Provider Enumeration Date:
10/04/2006