Provider First Line Business Practice Location Address:
770 WASHINGTON ST
Provider Second Line Business Practice Location Address:
#101
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-2209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-229-9530
Provider Business Practice Location Address Fax Number:
619-296-5316
Provider Enumeration Date:
06/23/2006