Provider First Line Business Practice Location Address:
8899 UNIVERSITY CENTER LN
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92122-1013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-794-0073
Provider Business Practice Location Address Fax Number:
702-696-0554
Provider Enumeration Date:
06/27/2008