Provider First Line Business Practice Location Address:
5333 MISSION CENTER RD
Provider Second Line Business Practice Location Address:
SUITE 354
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-1302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-281-0616
Provider Business Practice Location Address Fax Number:
619-528-1263
Provider Enumeration Date:
10/07/2008