Provider First Line Business Practice Location Address:
7675 DAGGET ST
Provider Second Line Business Practice Location Address:
#160
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92111-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-292-4566
Provider Business Practice Location Address Fax Number:
858-292-5217
Provider Enumeration Date:
01/17/2007