Provider First Line Business Practice Location Address:
1855 1ST AVE
Provider Second Line Business Practice Location Address:
STE. 200
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92101-2685
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-793-7988
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2006