Provider First Line Business Practice Location Address:
2345 FENTON PKWY
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:
92108-4743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-358-4049
Provider Business Practice Location Address Fax Number:
619-358-4048
Provider Enumeration Date:
03/12/2015