Provider First Line Business Practice Location Address:
3423 GUADALCANAL RD
Provider Second Line Business Practice Location Address:
BLDG 401 2ND DECK
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92155-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-537-1304
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/13/2012