Provider First Line Business Practice Location Address:
4060 FOURTH AVENUE
Provider Second Line Business Practice Location Address:
SUITE 640
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-299-3111
Provider Business Practice Location Address Fax Number:
619-255-5535
Provider Enumeration Date:
07/10/2006