Provider First Line Business Practice Location Address:
1250 6TH AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92101-4300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-810-8603
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2011