Provider First Line Business Practice Location Address:
3020 CHILDRENS WAY
Provider Second Line Business Practice Location Address:
MC 6013
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-4223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-576-1700
Provider Business Practice Location Address Fax Number:
619-420-5531
Provider Enumeration Date:
05/10/2007