Provider First Line Business Practice Location Address:
3939 3RD 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:
92103-3002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-765-2737
Provider Business Practice Location Address Fax Number:
619-692-0229
Provider Enumeration Date:
07/31/2006