Provider First Line Business Practice Location Address:
3525 FOURTH AVENUE
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:
92103-4912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-831-1841
Provider Business Practice Location Address Fax Number:
858-831-1841
Provider Enumeration Date:
05/26/2006