Provider First Line Business Practice Location Address:
2055 3RD AVE
Provider Second Line Business Practice Location Address:
SUITE NUMBER 100
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92101-2037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-233-8018
Provider Business Practice Location Address Fax Number:
619-233-8020
Provider Enumeration Date:
05/16/2007