Provider First Line Business Practice Location Address:
12520 HIGH BLUFF DR
Provider Second Line Business Practice Location Address:
STE 135
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92130-3066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-383-6700
Provider Business Practice Location Address Fax Number:
619-383-6701
Provider Enumeration Date:
06/09/2006