Provider First Line Business Practice Location Address:
9339 GENESEE AVE STE P39
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-2120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-452-9900
Provider Business Practice Location Address Fax Number:
858-455-1287
Provider Enumeration Date:
09/20/2006