Provider First Line Business Practice Location Address:
9323 CHESAPEAKE DR
Provider Second Line Business Practice Location Address:
SUITE #C1
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-1044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-278-7500
Provider Business Practice Location Address Fax Number:
858-278-7501
Provider Enumeration Date:
10/29/2012