Provider First Line Business Practice Location Address:
9353 CLAIREMONT MESA BLVD
Provider Second Line Business Practice Location Address:
STE K2
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-1220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-279-6500
Provider Business Practice Location Address Fax Number:
858-225-7174
Provider Enumeration Date:
06/21/2011