Provider First Line Business Practice Location Address:
11120 E OCEAN AIR DR
Provider Second Line Business Practice Location Address:
B105
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92130-4683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-792-7823
Provider Business Practice Location Address Fax Number:
858-792-7865
Provider Enumeration Date:
10/25/2008