Provider First Line Business Practice Location Address:
2729 4TH AVE STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-6223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-295-7312
Provider Business Practice Location Address Fax Number:
858-490-6292
Provider Enumeration Date:
04/22/2007