Provider First Line Business Practice Location Address:
4060 FAIRMOUNT AVE
Provider Second Line Business Practice Location Address:
PEDIATRICS DEPARTMENT
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-255-9154
Provider Business Practice Location Address Fax Number:
619-795-9847
Provider Enumeration Date:
06/14/2011