Provider First Line Business Practice Location Address:
610 GATEWAY CENTER WAY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92102-4533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-819-2220
Provider Business Practice Location Address Fax Number:
619-819-2212
Provider Enumeration Date:
02/21/2011