Provider First Line Business Practice Location Address:
4340 GENESEE AVE
Provider Second Line Business Practice Location Address:
#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:
92117-4940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-541-1844
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/20/2007