Provider First Line Business Practice Location Address:
2918 FIFTH AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-5910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-688-0770
Provider Business Practice Location Address Fax Number:
619-688-0987
Provider Enumeration Date:
04/22/2008