Provider First Line Business Practice Location Address:
12073 WORLD TRADE DR
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92128-4391
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-472-6632
Provider Business Practice Location Address Fax Number:
858-613-0524
Provider Enumeration Date:
09/18/2009