Provider First Line Business Practice Location Address:
8929 UNIVERSITY CENTER LANE
Provider Second Line Business Practice Location Address:
#208
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-457-1971
Provider Business Practice Location Address Fax Number:
858-457-0049
Provider Enumeration Date:
09/25/2006