Provider First Line Business Practice Location Address:
4282 GENESEE AVE STE 302
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:
92117-4985
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-836-2491
Provider Business Practice Location Address Fax Number:
858-836-2496
Provider Enumeration Date:
12/06/2018