Provider First Line Business Practice Location Address:
4501 MISSION BAY DR
Provider Second Line Business Practice Location Address:
SUITE 2B
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92109-4925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-272-1220
Provider Business Practice Location Address Fax Number:
858-490-2702
Provider Enumeration Date:
04/04/2008