Provider First Line Business Practice Location Address:
2500 SIXTH AVE.
Provider Second Line Business Practice Location Address:
UNIT 606
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-2122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-990-5656
Provider Business Practice Location Address Fax Number:
619-432-1853
Provider Enumeration Date:
02/06/2006