Provider First Line Business Practice Location Address:
4076 3RD AVE
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:
92103-2129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-534-2955
Provider Business Practice Location Address Fax Number:
619-298-2698
Provider Enumeration Date:
01/14/2011