Provider First Line Business Practice Location Address:
5465 MOREHOUSE DR
Provider Second Line Business Practice Location Address:
100
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-4700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-255-8070
Provider Business Practice Location Address Fax Number:
858-750-2428
Provider Enumeration Date:
04/06/2017