Provider First Line Business Practice Location Address:
2722 FIFTH AVE
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:
92103-6329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-688-3089
Provider Business Practice Location Address Fax Number:
619-688-9347
Provider Enumeration Date:
07/21/2006