Provider First Line Business Practice Location Address:
12090 SCRIPPS SUMMIT DR
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92131-4602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-547-8913
Provider Business Practice Location Address Fax Number:
858-547-8914
Provider Enumeration Date:
08/08/2007