Provider First Line Business Practice Location Address:
9261 FULLERTON AVE
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:
92123-3146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-516-0221
Provider Business Practice Location Address Fax Number:
858-496-9782
Provider Enumeration Date:
05/12/2006