Provider First Line Business Practice Location Address:
10672 WEXFORD STREET
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92131-3974
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-693-3000
Provider Business Practice Location Address Fax Number:
858-693-3700
Provider Enumeration Date:
05/16/2006