Provider First Line Business Practice Location Address:
4405 VANDEVER
Provider Second Line Business Practice Location Address:
2ND FLOOR PEDIATRICS
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-516-6166
Provider Business Practice Location Address Fax Number:
619-516-6132
Provider Enumeration Date:
05/01/2007