Provider First Line Business Practice Location Address:
6255 MISSION GORGE 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:
92120-3599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-285-6429
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/04/2007