Provider First Line Business Practice Location Address:
10755 SCRIPPS POWAY PKWY STE 581
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92131-3924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-433-7626
Provider Business Practice Location Address Fax Number:
877-240-8624
Provider Enumeration Date:
08/24/2005