Provider First Line Business Practice Location Address:
3435 CAMINO DEL RIO S
Provider Second Line Business Practice Location Address:
STE 122
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-3910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-574-0677
Provider Business Practice Location Address Fax Number:
858-695-9823
Provider Enumeration Date:
08/21/2006