Provider First Line Business Practice Location Address:
4732 POINT LOMA AVE
Provider Second Line Business Practice Location Address:
STE. D
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92107-3866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-222-5559
Provider Business Practice Location Address Fax Number:
619-955-5975
Provider Enumeration Date:
11/08/2006