Provider First Line Business Practice Location Address:
5650 MOUNT ACKERLY DR
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:
92111-4016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-304-3340
Provider Business Practice Location Address Fax Number:
858-569-2418
Provider Enumeration Date:
10/22/2007