Provider First Line Business Practice Location Address:
3368 SECOND AVE
Provider Second Line Business Practice Location Address:
STE A1
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-5666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-297-7174
Provider Business Practice Location Address Fax Number:
619-291-0901
Provider Enumeration Date:
08/05/2006