Provider First Line Business Practice Location Address:
10646 SCIENCE CENTER DR
Provider Second Line Business Practice Location Address:
CB10
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-1150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-622-8019
Provider Business Practice Location Address Fax Number:
877-481-5208
Provider Enumeration Date:
10/13/2006