Provider First Line Business Practice Location Address:
5555 RESERVOIR DR
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:
92120-5134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-822-1800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/16/2007