Provider First Line Business Practice Location Address:
3020 CHILDRENS WAY # MC6013
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:
92123-4223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-420-5611
Provider Business Practice Location Address Fax Number:
619-420-5531
Provider Enumeration Date:
03/22/2010