Provider First Line Business Practice Location Address:
3511 CAMINO DEL RIO S
Provider Second Line Business Practice Location Address:
SUITE 404
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-4003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-481-8416
Provider Business Practice Location Address Fax Number:
619-516-3993
Provider Enumeration Date:
09/22/2008