Provider First Line Business Practice Location Address:
3505 CAMINO DEL RIO S
Provider Second Line Business Practice Location Address:
SUITE 238
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-285-9981
Provider Business Practice Location Address Fax Number:
619-285-9982
Provider Enumeration Date:
09/06/2006