Provider First Line Business Practice Location Address:
1901 FOURTH AVENUE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92101-2381
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-236-1199
Provider Business Practice Location Address Fax Number:
619-236-0911
Provider Enumeration Date:
09/15/2006