Provider First Line Business Practice Location Address:
4926 LA CUENTA DR
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-890-0853
Provider Business Practice Location Address Fax Number:
760-635-1095
Provider Enumeration Date:
01/05/2007