Provider First Line Business Practice Location Address:
4045 3RD AVE
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-2132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-297-4901
Provider Business Practice Location Address Fax Number:
619-688-5994
Provider Enumeration Date:
04/02/2007