Provider First Line Business Practice Location Address:
5202 UNIVERSITY AVE
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:
92105-2268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-229-5461
Provider Business Practice Location Address Fax Number:
619-229-5489
Provider Enumeration Date:
03/21/2007