Provider First Line Business Practice Location Address:
3517 CAMINO DEL RIO S
Provider Second Line Business Practice Location Address:
215
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-4026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-584-5777
Provider Business Practice Location Address Fax Number:
619-584-5760
Provider Enumeration Date:
10/09/2009