Provider First Line Business Practice Location Address:
10201 WATERIDGE CIR
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:
92121-5800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-646-2454
Provider Business Practice Location Address Fax Number:
858-642-6242
Provider Enumeration Date:
08/18/2006