Provider First Line Business Practice Location Address:
3020 CHILDRENS WAY
Provider Second Line Business Practice Location Address:
MC5068
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:
760-758-1620
Provider Business Practice Location Address Fax Number:
760-945-0758
Provider Enumeration Date:
04/11/2008