Provider First Line Business Practice Location Address:
4405 VANDEVER 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:
92120-3315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-290-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2006