Provider First Line Business Practice Location Address:
8929 UNIVERSITY CENTER LN
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92122-1006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-453-6773
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2007