Provider First Line Business Practice Location Address:
8899 UNIVERSITY CENTER LN
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92122-1013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-452-1504
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/14/2005