Provider First Line Business Practice Location Address:
1015 TURQUOISE ST STE 1
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:
92109-1240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-274-6762
Provider Business Practice Location Address Fax Number:
858-274-6764
Provider Enumeration Date:
12/13/2006