Provider First Line Business Practice Location Address:
5450 CLAIREMONT MESA BLVD
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92117-2346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-292-1700
Provider Business Practice Location Address Fax Number:
858-292-1986
Provider Enumeration Date:
02/14/2012