Provider First Line Business Practice Location Address:
10121 CARROLL CANYON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92131-1109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-652-6900
Provider Business Practice Location Address Fax Number:
877-595-7208
Provider Enumeration Date:
03/25/2016