Provider First Line Business Practice Location Address:
3020 CHILDRENS WAY
Provider Second Line Business Practice Location Address:
MC5010
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-4223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-968-5838
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2007