Provider First Line Business Practice Location Address:
5405 MOREHOUSE DR
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-4722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-414-0042
Provider Business Practice Location Address Fax Number:
855-220-2433
Provider Enumeration Date:
12/19/2008