Provider First Line Business Practice Location Address:
7150 CLAIREMONT MESA BLVD
Provider Second Line Business Practice Location Address:
SUITE 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:
92111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-279-6771
Provider Business Practice Location Address Fax Number:
858-279-7505
Provider Enumeration Date:
11/28/2006