Provider First Line Business Practice Location Address:
200 WEST ARBOR DR
Provider Second Line Business Practice Location Address:
MAIL CODE 0039
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-0039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-822-0455
Provider Business Practice Location Address Fax Number:
619-543-3183
Provider Enumeration Date:
11/14/2006