Provider First Line Business Practice Location Address:
1465 MORENA BLVD
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:
92110-3725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-275-6565
Provider Business Practice Location Address Fax Number:
619-275-0300
Provider Enumeration Date:
12/05/2006