Provider First Line Business Practice Location Address:
3650 CLAIREMONT DR
Provider Second Line Business Practice Location Address:
#12
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92117-5908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-270-4242
Provider Business Practice Location Address Fax Number:
858-270-4241
Provider Enumeration Date:
05/17/2007