Provider First Line Business Practice Location Address:
3046 AVENIDA DE PORTUGAL
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:
92106-2650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-221-5000
Provider Business Practice Location Address Fax Number:
619-221-5003
Provider Enumeration Date:
05/03/2007