Provider First Line Business Practice Location Address:
1751 UNIVERSITY DR
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE TARGET CLINIC
Provider Business Practice Location Address City Name:
VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92083-7775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-941-0220
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2010