Provider First Line Business Practice Location Address:
1325 PACIFIC HWY
Provider Second Line Business Practice Location Address:
UNIT 3301
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92101-2580
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-876-2420
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/25/2012