Provider First Line Business Practice Location Address:
3555 KENYON STREET
Provider Second Line Business Practice Location Address:
SUITE 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:
92110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-550-8175
Provider Business Practice Location Address Fax Number:
619-358-9629
Provider Enumeration Date:
05/13/2009