Provider First Line Business Practice Location Address:
5780 CHESAPEAKE CT
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-1016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-292-5201
Provider Business Practice Location Address Fax Number:
858-292-5210
Provider Enumeration Date:
10/27/2006