Provider First Line Business Practice Location Address:
1901 1ST AVE.
Provider Second Line Business Practice Location Address:
STE 245
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-964-0722
Provider Business Practice Location Address Fax Number:
866-437-0375
Provider Enumeration Date:
06/29/2009