Provider First Line Business Practice Location Address:
5077 LOGAN AVE STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92113-3000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-262-4300
Provider Business Practice Location Address Fax Number:
619-262-4300
Provider Enumeration Date:
07/14/2009