Provider First Line Business Practice Location Address:
5353 MISSION CENTER RD STE 120
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:
92108-1304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-320-6128
Provider Business Practice Location Address Fax Number:
619-497-0254
Provider Enumeration Date:
02/21/2008