Provider First Line Business Practice Location Address:
8901 ACTIVITY RD
Provider Second Line Business Practice Location Address:
STE. D
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92126-4427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-535-6900
Provider Business Practice Location Address Fax Number:
619-535-6901
Provider Enumeration Date:
01/09/2013