Provider First Line Business Practice Location Address:
7420 CLAIRMONT MESA BLVD
Provider Second Line Business Practice Location Address:
SUITE 120
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:
858-514-8204
Provider Business Practice Location Address Fax Number:
858-514-8207
Provider Enumeration Date:
12/12/2006