Provider First Line Business Practice Location Address:
8304 CLAIREMONT MESA BLVD STE 114
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92111-1315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-565-8645
Provider Business Practice Location Address Fax Number:
858-565-4207
Provider Enumeration Date:
10/24/2006