Provider First Line Business Practice Location Address:
7071 CONSOLIDATED WAY
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:
92121-2604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-452-1200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2016