Provider First Line Business Practice Location Address:
12636 HIGH BLUFF DR STE 400
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:
92130-2071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-472-8959
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2006