Provider First Line Business Practice Location Address:
STE J
Provider Second Line Business Practice Location Address:
9833 PACIFIC HEIGHTS BLVD
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-4707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-458-0940
Provider Business Practice Location Address Fax Number:
858-458-3688
Provider Enumeration Date:
08/21/2006