Provider First Line Business Practice Location Address:
7808 CLAIREMONT MESA BLVD
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:
92111-1613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-384-2822
Provider Business Practice Location Address Fax Number:
858-384-2547
Provider Enumeration Date:
05/25/2016