Provider First Line Business Practice Location Address:
3177 OCEAN VIEW BLVD
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:
92113-1432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-231-9300
Provider Business Practice Location Address Fax Number:
619-398-1536
Provider Enumeration Date:
09/11/2007