Provider First Line Business Practice Location Address:
2535 KETTNER BLVD STE 1C1
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:
92101-1268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-269-6057
Provider Business Practice Location Address Fax Number:
619-269-6387
Provider Enumeration Date:
02/12/2009