Provider First Line Business Practice Location Address:
9655 GRANITE RIDGE DR STE 2000027
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:
92123-2674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-823-0204
Provider Business Practice Location Address Fax Number:
858-459-2128
Provider Enumeration Date:
10/26/2006