Provider First Line Business Practice Location Address:
1455 FRAZEE RD
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-844-1345
Provider Business Practice Location Address Fax Number:
619-354-7193
Provider Enumeration Date:
05/20/2014