Provider First Line Business Practice Location Address:
1111 6TH AVE
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-702-7113
Provider Business Practice Location Address Fax Number:
619-702-7114
Provider Enumeration Date:
04/25/2007