Provider First Line Business Practice Location Address:
9853 PACIFIC HEIGHTS BLVD
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-4721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-888-7700
Provider Business Practice Location Address Fax Number:
858-888-7721
Provider Enumeration Date:
10/02/2006