Provider First Line Business Practice Location Address:
9444 WAPLES ST
Provider Second Line Business Practice Location Address:
SUITE 450
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-2939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-804-8560
Provider Business Practice Location Address Fax Number:
858-412-1987
Provider Enumeration Date:
05/24/2013