Provider First Line Business Practice Location Address:
2423 CAMINO DEL RIO SOUTH
Provider Second Line Business Practice Location Address:
#103
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-994-1307
Provider Business Practice Location Address Fax Number:
619-293-3746
Provider Enumeration Date:
10/17/2006