Provider First Line Business Practice Location Address:
3434 MIDWAY DR
Provider Second Line Business Practice Location Address:
SUITE 2001
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92110-4923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-226-8871
Provider Business Practice Location Address Fax Number:
619-226-1456
Provider Enumeration Date:
03/05/2008