Provider First Line Business Practice Location Address:
12520 HIGH BLUFF DR
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92130-2041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-405-4423
Provider Business Practice Location Address Fax Number:
858-581-5788
Provider Enumeration Date:
08/18/2006