Provider First Line Business Practice Location Address:
3750 CONVOY ST
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92111-3738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-292-4313
Provider Business Practice Location Address Fax Number:
858-292-1612
Provider Enumeration Date:
12/07/2005