Provider First Line Business Practice Location Address:
1295 UNIVERSITY AVE STE 2
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-3333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-296-8012
Provider Business Practice Location Address Fax Number:
619-296-5269
Provider Enumeration Date:
09/21/2006