Provider First Line Business Practice Location Address:
7450 CLAIREMONT MESA BLVD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92111-1502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-268-3036
Provider Business Practice Location Address Fax Number:
858-268-3066
Provider Enumeration Date:
02/13/2007