Provider First Line Business Practice Location Address:
6035 UNIVERSITY AVE STE 31
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92115-6343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-610-8229
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/25/2015