Provider First Line Business Practice Location Address:
12310 WORLD TRADE DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92128-3793
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-576-6969
Provider Business Practice Location Address Fax Number:
858-974-6606
Provider Enumeration Date:
05/05/2006