Provider First Line Business Practice Location Address:
3345 SPORTS ARENA BLVD
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:
92110-4567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-222-5818
Provider Business Practice Location Address Fax Number:
619-222-5879
Provider Enumeration Date:
03/13/2015