Provider First Line Business Practice Location Address:
5465 MOREHOUSE DR STE 155
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-4713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-755-9600
Provider Business Practice Location Address Fax Number:
866-878-0094
Provider Enumeration Date:
11/07/2005