Provider First Line Business Practice Location Address:
3180 UNIVERSITY AVE STE 210
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:
92104-2046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-245-5374
Provider Business Practice Location Address Fax Number:
619-501-0295
Provider Enumeration Date:
02/02/2010