Provider First Line Business Practice Location Address:
301 UNIVERSITY AVE
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:
92103-3008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-325-0423
Provider Business Practice Location Address Fax Number:
619-325-0429
Provider Enumeration Date:
08/21/2013