Provider First Line Business Practice Location Address:
4305 GESNER ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92117-6639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-494-9597
Provider Business Practice Location Address Fax Number:
619-223-1802
Provider Enumeration Date:
01/30/2007