Provider First Line Business Practice Location Address:
12112 SCRIPPS SUMMIT DR STE C
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:
92134-1098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-530-0300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2010