Provider First Line Business Practice Location Address:
480 ALTA RD
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:
92179-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-661-6500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/04/2012