Provider First Line Business Practice Location Address:
6030 SANTO RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92124-1196
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-499-0200
Provider Business Practice Location Address Fax Number:
858-499-0224
Provider Enumeration Date:
01/13/2012