Provider First Line Business Practice Location Address:
3111 CAMINO DEL RIO N
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:
92108-5720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-641-7100
Provider Business Practice Location Address Fax Number:
619-641-7185
Provider Enumeration Date:
12/13/2006