Provider First Line Business Practice Location Address:
2051 CUSHING RD BLDG 624
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:
92106-6173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-881-9001
Provider Business Practice Location Address Fax Number:
619-524-0086
Provider Enumeration Date:
07/27/2006