Provider First Line Business Practice Location Address:
6540 LUSK BLVD STE C148
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:
92121-2767
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-658-0424
Provider Business Practice Location Address Fax Number:
888-826-6928
Provider Enumeration Date:
03/02/2007