Provider First Line Business Practice Location Address:
1640 CAMINO DEL RIO N
Provider Second Line Business Practice Location Address:
MISSION VALLEY CTR STE #200
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-1506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-299-3113
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2007