Provider First Line Business Practice Location Address:
8910 UNIVERSITY CENTER LANE
Provider Second Line Business Practice Location Address:
SUITE 670
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-558-8590
Provider Business Practice Location Address Fax Number:
858-558-8614
Provider Enumeration Date:
10/16/2009