Provider First Line Business Practice Location Address:
2017 1ST 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:
92101-2033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-881-4577
Provider Business Practice Location Address Fax Number:
619-231-1031
Provider Enumeration Date:
04/16/2007