Provider First Line Business Practice Location Address:
4595 CLAIREMONT DR
Provider Second Line Business Practice Location Address:
CLAIREMONT
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92117-5540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-272-1051
Provider Business Practice Location Address Fax Number:
858-272-7466
Provider Enumeration Date:
12/27/2006