Provider First Line Business Practice Location Address:
7851 MISSION CENTER CT
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-1325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-574-1144
Provider Business Practice Location Address Fax Number:
619-923-2635
Provider Enumeration Date:
01/18/2011