Provider First Line Business Practice Location Address:
11081 CLAIREMONT MESA BLVD
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:
92124-1506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-431-9303
Provider Business Practice Location Address Fax Number:
858-737-4009
Provider Enumeration Date:
10/23/2006