Provider First Line Business Practice Location Address:
4433 CONVOY ST
Provider Second Line Business Practice Location Address:
SUITE NUMBER E
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92111-3736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-621-1272
Provider Business Practice Location Address Fax Number:
619-934-3300
Provider Enumeration Date:
03/20/2007