Provider First Line Business Practice Location Address:
5382 CLAIREMONT MESA BLVD
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:
92117-2213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-277-6620
Provider Business Practice Location Address Fax Number:
858-277-6256
Provider Enumeration Date:
11/01/2006