Provider First Line Business Practice Location Address:
5219 CLAIREMONT MESA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92117-2206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-292-8044
Provider Business Practice Location Address Fax Number:
858-292-9644
Provider Enumeration Date:
12/07/2009