Provider First Line Business Practice Location Address:
2351 CARDINAL LN # B
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:
92123-3743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-525-7372
Provider Business Practice Location Address Fax Number:
619-744-7671
Provider Enumeration Date:
12/10/2007