Provider First Line Business Practice Location Address:
5296 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SUITE J
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92105-2269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-287-7835
Provider Business Practice Location Address Fax Number:
619-287-2307
Provider Enumeration Date:
09/27/2007