Provider First Line Business Practice Location Address:
3636 4TH AVE STE 304
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:
92103-4294
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-482-8827
Provider Business Practice Location Address Fax Number:
858-244-0990
Provider Enumeration Date:
06/20/2006