Provider First Line Business Practice Location Address:
10145 PACIFIC HEIGHTS BLVD
Provider Second Line Business Practice Location Address:
STE 700
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-4234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-554-0799
Provider Business Practice Location Address Fax Number:
858-554-1306
Provider Enumeration Date:
12/27/2006