Provider First Line Business Practice Location Address:
10636 SCRIPPS SUMMIT CT STE 142
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:
92131-3979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-566-9020
Provider Business Practice Location Address Fax Number:
858-566-9021
Provider Enumeration Date:
03/13/2012