Provider First Line Business Practice Location Address:
8930 ACTIVITY RD
Provider Second Line Business Practice Location Address:
SUITE K
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92126-4457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-693-4123
Provider Business Practice Location Address Fax Number:
858-693-8071
Provider Enumeration Date:
07/08/2006