Provider First Line Business Practice Location Address:
8940 ACTIVITY RD
Provider Second Line Business Practice Location Address:
SUITE K
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92126-4460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-466-1892
Provider Business Practice Location Address Fax Number:
800-405-2482
Provider Enumeration Date:
06/18/2007