Provider First Line Business Practice Location Address:
8929 UNIVERSITY CENTER LN
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92122-1006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-412-3271
Provider Business Practice Location Address Fax Number:
858-412-3186
Provider Enumeration Date:
12/31/2005