Provider First Line Business Practice Location Address:
5000 N HARBOR DR
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92106-2386
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-847-7948
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2011