Provider First Line Business Practice Location Address:
2333 FIRST AVE
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92101-1538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-795-1975
Provider Business Practice Location Address Fax Number:
619-795-1976
Provider Enumeration Date:
04/09/2013