Provider First Line Business Practice Location Address:
7380 CLAIREMONT MESA BLVD
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:
92111-1116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-715-8080
Provider Business Practice Location Address Fax Number:
858-715-8081
Provider Enumeration Date:
09/25/2014