Provider First Line Business Practice Location Address:
12625 HIGH BLUFF DRIVE
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-230-3439
Provider Business Practice Location Address Fax Number:
858-792-8333
Provider Enumeration Date:
02/23/2007