Provider First Line Business Practice Location Address:
4103 3RD AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-1408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-299-3200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2008