Provider First Line Business Practice Location Address:
5060 SHOREHAM PL
Provider Second Line Business Practice Location Address:
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:
92122-5903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-334-4640
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/30/2012