Provider First Line Business Practice Location Address:
3555 KENYON ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92110-5341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-221-9547
Provider Business Practice Location Address Fax Number:
619-224-7269
Provider Enumeration Date:
08/31/2006