Provider First Line Business Practice Location Address:
2251 SAN DIEGO AVE
Provider Second Line Business Practice Location Address:
STE B105
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-295-9525
Provider Business Practice Location Address Fax Number:
619-542-0069
Provider Enumeration Date:
02/01/2007