Provider First Line Business Practice Location Address:
1650 HENDERSON AVE
Provider Second Line Business Practice Location Address:
BLDG 310
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-524-8673
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2007