Provider First Line Business Practice Location Address:
3132 JEFFERSON ST
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:
92110-4421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-683-3100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/26/2017