Provider First Line Business Practice Location Address:
7930 FROST ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-2737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-492-9977
Provider Business Practice Location Address Fax Number:
858-492-9910
Provider Enumeration Date:
02/29/2012