Provider First Line Business Practice Location Address:
3815 3RD AVE
Provider Second Line Business Practice Location Address:
#24
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-3077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-793-0566
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2006