Provider First Line Business Practice Location Address:
34800 BOB WILSON DR
Provider Second Line Business Practice Location Address:
BLDG. 1, 3RD FLOOR
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92134-1208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-532-8858
Provider Business Practice Location Address Fax Number:
619-532-3501
Provider Enumeration Date:
12/15/2010