Provider First Line Business Practice Location Address:
3737 MORAGA AVE
Provider Second Line Business Practice Location Address:
STE A3
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92117-5486
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-755-1885
Provider Business Practice Location Address Fax Number:
619-276-6362
Provider Enumeration Date:
04/10/2007