Provider First Line Business Practice Location Address:
12486 RIOS RD
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:
92128-2841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-217-7083
Provider Business Practice Location Address Fax Number:
619-326-8952
Provider Enumeration Date:
08/01/2006