Provider First Line Business Practice Location Address:
16918 DOVE CANYON RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92127-3445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-649-5100
Provider Business Practice Location Address Fax Number:
858-649-5099
Provider Enumeration Date:
05/26/2006