Provider First Line Business Practice Location Address:
15250 AVENUE OF SCIENCE
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:
92128-3406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-521-2734
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/03/2026