Provider First Line Business Practice Location Address:
10755 SCRIPPS POWAY PKWY
Provider Second Line Business Practice Location Address:
SUITE 455
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92131-3924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-751-4798
Provider Business Practice Location Address Fax Number:
717-798-9898
Provider Enumeration Date:
10/27/2010