Provider First Line Business Practice Location Address:
2355 NORTHSIDE DR.
Provider Second Line Business Practice Location Address:
SUITE 100 THERASTAFF
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-2714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
185-843-6530
Provider Business Practice Location Address Fax Number:
800-863-2978
Provider Enumeration Date:
11/15/2012