Provider First Line Business Practice Location Address:
8787 COMPLEX DR
Provider Second Line Business Practice Location Address:
STE 204
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-1453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-279-7600
Provider Business Practice Location Address Fax Number:
858-874-5814
Provider Enumeration Date:
08/09/2006