Provider First Line Business Practice Location Address:
16950 VIA TAZON
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:
92127-1607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-521-2300
Provider Business Practice Location Address Fax Number:
858-231-9084
Provider Enumeration Date:
10/17/2006