Provider First Line Business Practice Location Address:
10645 TIERRASANTA BLVD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92124-2614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-277-6080
Provider Business Practice Location Address Fax Number:
858-277-4773
Provider Enumeration Date:
09/26/2006