Provider First Line Business Practice Location Address:
12340 EL CAMINO REAL STE 500
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:
92130-3078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-450-4222
Provider Business Practice Location Address Fax Number:
858-200-3877
Provider Enumeration Date:
07/23/2014