Provider First Line Business Practice Location Address:
4282 GENESEE AVE
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92117-4964
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-268-0300
Provider Business Practice Location Address Fax Number:
858-268-3894
Provider Enumeration Date:
06/10/2005