Provider First Line Business Practice Location Address:
4305 UNIVERSITY AVE STE 120
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:
92105-1645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-285-8135
Provider Business Practice Location Address Fax Number:
619-795-3743
Provider Enumeration Date:
04/17/2013