Provider First Line Business Practice Location Address:
300 FIR ST
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:
92101-2327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-446-1560
Provider Business Practice Location Address Fax Number:
619-446-1692
Provider Enumeration Date:
06/28/2012