Provider First Line Business Practice Location Address:
5405 UNIVERSITY AVE
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:
92105-2304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-229-6689
Provider Business Practice Location Address Fax Number:
619-286-1659
Provider Enumeration Date:
10/24/2005