Provider First Line Business Practice Location Address:
350 DICKINSON ST
Provider Second Line Business Practice Location Address:
SUITE 121
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-1913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-543-2539
Provider Business Practice Location Address Fax Number:
619-543-2540
Provider Enumeration Date:
10/04/2005