Provider First Line Business Practice Location Address:
6147 UNIVERSITY 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:
92115-5720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-582-3871
Provider Business Practice Location Address Fax Number:
619-582-3999
Provider Enumeration Date:
03/14/2008