Provider First Line Business Practice Location Address:
500 3RD 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:
92101-6805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-321-0093
Provider Business Practice Location Address Fax Number:
619-321-0094
Provider Enumeration Date:
09/27/2012