Provider First Line Business Practice Location Address:
8001 FROST ST
Provider Second Line Business Practice Location Address:
ENTRANCE 10
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-2746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-966-8052
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/13/2006