Provider First Line Business Practice Location Address:
3443 CAMINO DEL RIO S
Provider Second Line Business Practice Location Address:
STE. 202
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-3903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-284-8755
Provider Business Practice Location Address Fax Number:
619-563-0240
Provider Enumeration Date:
06/26/2008