Provider First Line Business Practice Location Address:
3110 CAMINO DEL RIO S STE 219
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:
92108-3831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-280-6622
Provider Business Practice Location Address Fax Number:
619-441-1225
Provider Enumeration Date:
08/01/2006