Provider First Line Business Practice Location Address:
9834 GENESEE AVE STE 223B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA JOLLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92037-1215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
582-777-1238
Provider Business Practice Location Address Fax Number:
619-582-2860
Provider Enumeration Date:
08/31/2006