Provider First Line Business Practice Location Address:
9339 GENESEE AVE STE 220
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:
92121-2196
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-455-1248
Provider Business Practice Location Address Fax Number:
858-455-5461
Provider Enumeration Date:
04/14/2014