Provider First Line Business Practice Location Address:
9255 TOWNE CENTRE DR
Provider Second Line Business Practice Location Address:
SUITE 875
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-3033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-455-5252
Provider Business Practice Location Address Fax Number:
858-455-5556
Provider Enumeration Date:
10/05/2005