Provider First Line Business Practice Location Address:
286 EUCLID AVE
Provider Second Line Business Practice Location Address:
SUITE #302
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92114-3616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-662-4100
Provider Business Practice Location Address Fax Number:
619-428-7952
Provider Enumeration Date:
01/29/2008