Provider First Line Business Practice Location Address:
10605 SCRIPPS POWAY PKWY
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:
92131-3925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-622-0554
Provider Business Practice Location Address Fax Number:
858-622-1417
Provider Enumeration Date:
06/19/2012