Provider First Line Business Practice Location Address:
12625 HIGH BLUFF DR
Provider Second Line Business Practice Location Address:
SUITE 114
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92130-2052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-835-9972
Provider Business Practice Location Address Fax Number:
858-847-0497
Provider Enumeration Date:
10/24/2008