Provider First Line Business Practice Location Address:
4747 MORENA BLVD
Provider Second Line Business Practice Location Address:
375
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92117-3465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-270-6614
Provider Business Practice Location Address Fax Number:
858-483-0405
Provider Enumeration Date:
12/15/2006