Provider First Line Business Practice Location Address:
4315 MOUNT PUTMAN AVE
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:
92117-4750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-344-6045
Provider Business Practice Location Address Fax Number:
858-567-4462
Provider Enumeration Date:
05/02/2011