Provider First Line Business Practice Location Address:
8250 VICKERS ST
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92111-2117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-576-6900
Provider Business Practice Location Address Fax Number:
858-576-8198
Provider Enumeration Date:
10/23/2006