Provider First Line Business Practice Location Address:
913 CATALINA BLVD
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:
92106-2838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-223-0300
Provider Business Practice Location Address Fax Number:
619-221-0374
Provider Enumeration Date:
12/07/2009