Provider First Line Business Practice Location Address:
50 ROSECRANS ST BLDG 500
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:
92106-4408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-553-0724
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2010