Provider First Line Business Practice Location Address:
2204 GARNET AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92109-3771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-274-5572
Provider Business Practice Location Address Fax Number:
858-274-5572
Provider Enumeration Date:
05/08/2006