Provider First Line Business Practice Location Address:
12396 WORLD TRADE DR STE 117
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:
92128-3788
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-458-0625
Provider Business Practice Location Address Fax Number:
858-750-2174
Provider Enumeration Date:
03/07/2013