Provider First Line Business Practice Location Address:
34520 BOB WILSON DR
Provider Second Line Business Practice Location Address:
ENT DEPT -- BLDG 2, 2ND FLOOR
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92134-2098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-532-8164
Provider Business Practice Location Address Fax Number:
619-532-7243
Provider Enumeration Date:
02/01/2006