Provider First Line Business Practice Location Address:
230 PROSPECT PL
Provider Second Line Business Practice Location Address:
SUITE 340 B
Provider Business Practice Location Address City Name:
CORONADO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92118-1978
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-522-4000
Provider Business Practice Location Address Fax Number:
619-435-0151
Provider Enumeration Date:
02/16/2007