Provider First Line Business Practice Location Address:
8810 RIO SAN DIEGO DR
Provider Second Line Business Practice Location Address:
COMP & PEN DEPT
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-1622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-459-7101
Provider Business Practice Location Address Fax Number:
858-454-2146
Provider Enumeration Date:
08/18/2006