Provider First Line Business Practice Location Address:
411 CAMINO DEL RIO S
Provider Second Line Business Practice Location Address:
101
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-3530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-574-8181
Provider Business Practice Location Address Fax Number:
619-574-0802
Provider Enumeration Date:
07/31/2008