Provider First Line Business Practice Location Address:
9445 FARNHAM ST STE 100
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:
92123-1308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-380-4676
Provider Business Practice Location Address Fax Number:
858-380-4676
Provider Enumeration Date:
10/10/2006