Provider First Line Business Practice Location Address:
11616 IBERIA PLACE
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:
92128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-676-5000
Provider Business Practice Location Address Fax Number:
858-676-5016
Provider Enumeration Date:
11/29/2006