Provider First Line Business Practice Location Address:
5850 OBERLIN DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-4719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-602-6167
Provider Business Practice Location Address Fax Number:
858-638-1957
Provider Enumeration Date:
02/18/2009