Provider First Line Business Practice Location Address:
3703 CAMINO DEL RIO S
Provider Second Line Business Practice Location Address:
STE. 100A
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-4031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-269-2336
Provider Business Practice Location Address Fax Number:
619-269-7608
Provider Enumeration Date:
02/12/2007