Provider First Line Business Practice Location Address:
4145 DEL MAR TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92130-2218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-794-7809
Provider Business Practice Location Address Fax Number:
858-794-7809
Provider Enumeration Date:
06/07/2006