Provider First Line Business Practice Location Address:
11255 LAKERIM 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:
92131-2312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-610-2080
Provider Business Practice Location Address Fax Number:
858-530-0005
Provider Enumeration Date:
03/09/2007