Provider First Line Business Practice Location Address:
12400 HIGH BLUFF DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92130-3077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-792-0711
Provider Business Practice Location Address Fax Number:
866-803-9448
Provider Enumeration Date:
08/12/2013