Provider First Line Business Practice Location Address:
3330 3RD AVE
Provider Second Line Business Practice Location Address:
SUITE A & B
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-5639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-291-8750
Provider Business Practice Location Address Fax Number:
619-291-7536
Provider Enumeration Date:
08/25/2006