Provider First Line Business Practice Location Address:
10992 SAN DIEGO MISSION RD
Provider Second Line Business Practice Location Address:
PEDIATRICS ADMINISTRATION, 3RD FLOOR
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-2444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-542-7210
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2012