Provider First Line Business Practice Location Address:
4716 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:
92117-2006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-270-4588
Provider Business Practice Location Address Fax Number:
858-272-8030
Provider Enumeration Date:
12/05/2006