Provider First Line Business Practice Location Address:
12625 HIGH BLUFF DRIVE SUITE 202, SAN DIEGO CA 92130
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-255-0849
Provider Business Practice Location Address Fax Number:
415-476-7722
Provider Enumeration Date:
09/16/2008