Provider First Line Business Practice Location Address:
6160 MISSION GORGE RD
Provider Second Line Business Practice Location Address:
100
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92120-3410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-481-3790
Provider Business Practice Location Address Fax Number:
619-481-3797
Provider Enumeration Date:
03/10/2015