Provider First Line Business Practice Location Address:
5225 KEARNY VILLA WAY
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:
92123-1410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-974-7200
Provider Business Practice Location Address Fax Number:
858-627-0076
Provider Enumeration Date:
06/20/2016