Provider First Line Business Practice Location Address:
4320 GENESEE AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92117-4900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-292-6051
Provider Business Practice Location Address Fax Number:
858-565-1855
Provider Enumeration Date:
08/15/2006