Provider First Line Business Practice Location Address:
1764 SAN DIEGO AVE STE 100
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:
92110-1987
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-298-0800
Provider Business Practice Location Address Fax Number:
619-298-8080
Provider Enumeration Date:
03/28/2007