Provider First Line Business Practice Location Address:
34101 FARENHOLT AVE
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:
92134-7000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-830-3749
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/02/2014