Provider First Line Business Practice Location Address:
1090 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
202B
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-7307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-295-6009
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2008