Provider First Line Business Practice Location Address:
2333 1ST AVE
Provider Second Line Business Practice Location Address:
STE 203
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92101-1596
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-735-3628
Provider Business Practice Location Address Fax Number:
619-685-0042
Provider Enumeration Date:
10/20/2010