Provider First Line Business Practice Location Address:
4242 CAMINO DEL RIO N STE 24
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:
92108-2613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-640-3400
Provider Business Practice Location Address Fax Number:
619-283-2584
Provider Enumeration Date:
11/24/2006