Provider First Line Business Practice Location Address:
3020 CHILDREN'S WAY MAIL CODE 5130
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:
92123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-533-3529
Provider Business Practice Location Address Fax Number:
619-533-3558
Provider Enumeration Date:
05/18/2007