Provider First Line Business Practice Location Address:
10672 WEXFORD ST STE 280
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:
92131-3973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-412-7362
Provider Business Practice Location Address Fax Number:
858-368-9797
Provider Enumeration Date:
12/06/2005