Provider First Line Business Practice Location Address:
2850 6TH AVE
Provider Second Line Business Practice Location Address:
SUITE 412
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-6308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-422-2555
Provider Business Practice Location Address Fax Number:
619-422-2223
Provider Enumeration Date:
01/01/2007