Provider First Line Business Practice Location Address:
6035 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SUITE 24
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92115-6341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-424-0471
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2008