Provider First Line Business Practice Location Address:
3255 CAMINO DEL RIO S
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:
92108-3806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-563-2701
Provider Business Practice Location Address Fax Number:
619-563-2705
Provider Enumeration Date:
03/29/2007