Provider First Line Business Practice Location Address:
6155 CORNERSTONE COURT EAST
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-4737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-458-2992
Provider Business Practice Location Address Fax Number:
858-458-3655
Provider Enumeration Date:
07/20/2005