Provider First Line Business Practice Location Address:
2445 TRUXTON RD.
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92106-6154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-554-7439
Provider Business Practice Location Address Fax Number:
619-272-5239
Provider Enumeration Date:
09/23/2005