Provider First Line Business Practice Location Address:
1666 GARNET AVE # 409
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:
92109-3116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-235-2600
Provider Business Practice Location Address Fax Number:
619-696-9573
Provider Enumeration Date:
12/28/2006