Provider First Line Business Practice Location Address:
2525 CAMINO DEL RIO SOUTH
Provider Second Line Business Practice Location Address:
SUITE 130, ROOM 3
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-3718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-929-0032
Provider Business Practice Location Address Fax Number:
208-728-8168
Provider Enumeration Date:
07/07/2006