Provider First Line Business Practice Location Address:
2251 SAN DIEGO AVE
Provider Second Line Business Practice Location Address:
SUITE A-235
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92110-3003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-223-2779
Provider Business Practice Location Address Fax Number:
619-223-2772
Provider Enumeration Date:
11/17/2009