Provider First Line Business Practice Location Address:
3940 HOME AVE
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:
92105-5952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-262-8000
Provider Business Practice Location Address Fax Number:
619-266-7405
Provider Enumeration Date:
05/07/2013