Provider First Line Business Practice Location Address:
3010 CHILDRENS WAY
Provider Second Line Business Practice Location Address:
2-WEST
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:
858-966-5811
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/29/2010