Provider First Line Business Practice Location Address:
350 K ST UNIT 303
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92101-6992
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-421-1111
Provider Business Practice Location Address Fax Number:
619-421-1504
Provider Enumeration Date:
06/25/2007