Provider First Line Business Practice Location Address:
3660 CLAIREMONT DR
Provider Second Line Business Practice Location Address:
STE. 11
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92117-5909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-270-6651
Provider Business Practice Location Address Fax Number:
858-270-6654
Provider Enumeration Date:
09/26/2006