Provider First Line Business Practice Location Address:
8695 SPECTRUM CENTER BLVD
Provider Second Line Business Practice Location Address:
ROOM 119
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-1489
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-499-5259
Provider Business Practice Location Address Fax Number:
858-499-5317
Provider Enumeration Date:
04/04/2007