Provider First Line Business Practice Location Address:
3420 KENYON ST
Provider Second Line Business Practice Location Address:
BLDG B, 2ND FLOOR
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92110-5001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-496-0450
Provider Business Practice Location Address Fax Number:
619-221-6565
Provider Enumeration Date:
07/21/2010