Provider First Line Business Practice Location Address:
10737 CAMINO RUIZ
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-653-0147
Provider Business Practice Location Address Fax Number:
858-653-0432
Provider Enumeration Date:
09/26/2005