Provider First Line Business Practice Location Address:
1380 GARNET AVE STE D
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:
92109-3013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-272-2581
Provider Business Practice Location Address Fax Number:
858-272-9639
Provider Enumeration Date:
01/23/2014