Provider First Line Business Practice Location Address:
2254 SAN DIEGO AVE
Provider Second Line Business Practice Location Address:
SUITE 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:
92110-2944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-260-6110
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2014