Provider First Line Business Practice Location Address:
3633 CAMINO DEL RIO S
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-4011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-260-8200
Provider Business Practice Location Address Fax Number:
619-260-8288
Provider Enumeration Date:
09/27/2005