Provider First Line Business Practice Location Address:
2525 CAMINO DEL RIO S
Provider Second Line Business Practice Location Address:
STE 205
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-542-1426
Provider Business Practice Location Address Fax Number:
619-294-3012
Provider Enumeration Date:
03/28/2007