Provider First Line Business Practice Location Address:
2207 GARNET AVE STE F
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:
92109-3713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-736-9205
Provider Business Practice Location Address Fax Number:
858-952-1011
Provider Enumeration Date:
07/14/2008