Provider First Line Business Practice Location Address:
3020 CHILDREN'S WAY
Provider Second Line Business Practice Location Address:
MC 5042
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-966-7453
Provider Business Practice Location Address Fax Number:
858-966-8011
Provider Enumeration Date:
08/06/2013