Provider First Line Business Practice Location Address:
2496 BAUER ROAD
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:
92145-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-307-6252
Provider Business Practice Location Address Fax Number:
858-307-7754
Provider Enumeration Date:
01/10/2007