Provider First Line Business Practice Location Address:
1465 30TH ST
Provider Second Line Business Practice Location Address:
STE. 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:
92154-3497
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-428-1000
Provider Business Practice Location Address Fax Number:
619-428-1091
Provider Enumeration Date:
08/03/2012