Provider First Line Business Practice Location Address:
4980 ARVINELS 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:
92117-2324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-278-3518
Provider Business Practice Location Address Fax Number:
858-571-1918
Provider Enumeration Date:
12/29/2009