Provider First Line Business Practice Location Address:
12925 EL CAMINO REAL
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92130-1891
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-348-5900
Provider Business Practice Location Address Fax Number:
858-617-0780
Provider Enumeration Date:
07/05/2006