Provider First Line Business Practice Location Address:
3023 BUNKER HILL ST
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92109-5706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-688-7294
Provider Business Practice Location Address Fax Number:
858-746-4212
Provider Enumeration Date:
09/30/2005