Provider First Line Business Practice Location Address:
8222 VICKERS ST
Provider Second Line Business Practice Location Address:
STE 108
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92111-2118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-292-4040
Provider Business Practice Location Address Fax Number:
858-292-5272
Provider Enumeration Date:
09/05/2005