Provider First Line Business Practice Location Address:
2365 NORTHSIDE DR STE 100
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:
92108-2710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-757-2700
Provider Business Practice Location Address Fax Number:
760-871-0713
Provider Enumeration Date:
08/05/2010