Provider First Line Business Practice Location Address:
3737 MORAGA AVE
Provider Second Line Business Practice Location Address:
B-206
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92117-5492
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-273-0700
Provider Business Practice Location Address Fax Number:
858-273-8679
Provider Enumeration Date:
07/17/2012