Provider First Line Business Practice Location Address:
7750 DAGGET ST STE 104
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:
92111-2235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-874-3000
Provider Business Practice Location Address Fax Number:
858-277-6661
Provider Enumeration Date:
05/17/2007