Provider First Line Business Practice Location Address:
1850 CORONADO AVE
Provider Second Line Business Practice Location Address:
SUITE 404
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92154-2046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-423-1991
Provider Business Practice Location Address Fax Number:
619-423-1918
Provider Enumeration Date:
01/15/2007