Provider First Line Business Practice Location Address:
11760 SORRENTO VALLEY RD
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-1018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-481-8485
Provider Business Practice Location Address Fax Number:
858-481-8472
Provider Enumeration Date:
06/24/2006