Provider First Line Business Practice Location Address:
4452 PARK BLVD
Provider Second Line Business Practice Location Address:
SUITE 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:
92116-4051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-294-3500
Provider Business Practice Location Address Fax Number:
619-232-9923
Provider Enumeration Date:
08/06/2006