Provider First Line Business Practice Location Address: 
5440 MOREHOUSE DR STE 2900
    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: 
92121-6704
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
858-457-8419
    Provider Business Practice Location Address Fax Number: 
858-457-0670
    Provider Enumeration Date: 
06/18/2006