Provider First Line Business Practice Location Address:
9880 HIBERT ST
Provider Second Line Business Practice Location Address:
SUITE E-1
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92131-1068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-693-9044
Provider Business Practice Location Address Fax Number:
858-693-0704
Provider Enumeration Date:
10/05/2005