Provider First Line Business Practice Location Address:
1919 GRAND AVENUE, SUITE 1-P
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:
92109-4569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-272-5588
Provider Business Practice Location Address Fax Number:
858-274-5904
Provider Enumeration Date:
05/07/2007