Provider First Line Business Practice Location Address:
12040 CAMINITO CAMPANA
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:
92128-2014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-472-7280
Provider Business Practice Location Address Fax Number:
858-217-6567
Provider Enumeration Date:
09/25/2014