Provider First Line Business Practice Location Address:
2495 TRUXTUN RD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92106-6159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-758-9004
Provider Business Practice Location Address Fax Number:
619-758-9403
Provider Enumeration Date:
11/02/2007