Provider First Line Business Practice Location Address:
15025 INNOVATION DR
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:
92128-3455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-547-8487
Provider Business Practice Location Address Fax Number:
858-578-5372
Provider Enumeration Date:
02/23/2006