Provider First Line Business Practice Location Address:
2450 CRAVEN ST
Provider Second Line Business Practice Location Address:
BLDG 3300
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92136-5599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-556-8086
Provider Business Practice Location Address Fax Number:
619-532-5898
Provider Enumeration Date:
09/20/2006