Provider First Line Business Practice Location Address:
4525 CAMPUS AVE
Provider Second Line Business Practice Location Address:
#8
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-228-5661
Provider Business Practice Location Address Fax Number:
808-257-5653
Provider Enumeration Date:
09/21/2005