Provider First Line Business Practice Location Address:
5060 SHOREHAM PL STE 100
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:
92122-5904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-427-5060
Provider Business Practice Location Address Fax Number:
619-383-6701
Provider Enumeration Date:
09/23/2011