Provider First Line Business Practice Location Address:
200 WEST ARBOR DRIVE
Provider Second Line Business Practice Location Address:
MAIL CODE 9111D
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-9111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-534-5495
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2006