Provider First Line Business Practice Location Address:
11752 EL CAMINO REAL
Provider Second Line Business Practice Location Address:
SUITE 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:
92130-2050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-793-9591
Provider Business Practice Location Address Fax Number:
858-793-0431
Provider Enumeration Date:
05/18/2011