Provider First Line Business Practice Location Address:
3550 AFTON RD
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:
92123-2184
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-637-3524
Provider Business Practice Location Address Fax Number:
858-284-9848
Provider Enumeration Date:
08/05/2006