Provider First Line Business Practice Location Address:
1050 UNIVERSITY AVE STE E107
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:
92103-3359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-504-7743
Provider Business Practice Location Address Fax Number:
858-216-1928
Provider Enumeration Date:
04/01/2011