Provider First Line Business Practice Location Address:
8929 UNIVERSITY CENTER LN
Provider Second Line Business Practice Location Address:
STE # 200
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:
858-457-3545
Provider Business Practice Location Address Fax Number:
858-457-0976
Provider Enumeration Date:
07/22/2006