Provider First Line Business Practice Location Address:
4344 CONVOY ST. STE T .
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:
92111-3737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-277-5463
Provider Business Practice Location Address Fax Number:
858-279-8296
Provider Enumeration Date:
10/04/2006