Provider First Line Business Practice Location Address:
3131 BERGER AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-4233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-244-6865
Provider Business Practice Location Address Fax Number:
858-244-6892
Provider Enumeration Date:
03/01/2006