Provider First Line Business Practice Location Address:
5820 OBERLIN DR STE 204
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:
92121-3742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-678-8900
Provider Business Practice Location Address Fax Number:
858-678-8990
Provider Enumeration Date:
10/23/2006