Provider First Line Business Practice Location Address:
5465 MOREHOUSE DR 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:
92121-4713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-255-8070
Provider Business Practice Location Address Fax Number:
858-750-2428
Provider Enumeration Date:
03/29/2012