Provider First Line Business Practice Location Address:
4715 VIEWRIDGE AVENUE
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-454-3610
Provider Business Practice Location Address Fax Number:
800-819-1655
Provider Enumeration Date:
11/10/2009