Provider First Line Business Practice Location Address:
250 PROSPECT PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORONADO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92118-1943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-522-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/29/2016