Provider First Line Business Practice Location Address:
8787 COMPLEX DR
Provider Second Line Business Practice Location Address:
130
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-1419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-882-3100
Provider Business Practice Location Address Fax Number:
858-278-9818
Provider Enumeration Date:
06/03/2016