Provider First Line Business Practice Location Address:
4235 CONVOY ST
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:
92111-3703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-715-9400
Provider Business Practice Location Address Fax Number:
858-715-9550
Provider Enumeration Date:
06/16/2006