Provider First Line Business Practice Location Address:
6540 LUSK BLVD
Provider Second Line Business Practice Location Address:
SUITE C-159
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-2766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-202-1777
Provider Business Practice Location Address Fax Number:
858-202-1701
Provider Enumeration Date:
04/23/2008