Provider First Line Business Practice Location Address:
5550 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92105-2307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-495-0971
Provider Business Practice Location Address Fax Number:
858-495-0991
Provider Enumeration Date:
06/26/2006