Provider First Line Business Practice Location Address:
4462 OLNEY ST
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:
92109-4742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-274-8000
Provider Business Practice Location Address Fax Number:
858-274-0312
Provider Enumeration Date:
01/01/2007