Provider First Line Business Practice Location Address:
3075 HEALTH CENTER DR STE 401
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:
92123-2773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
589-395-4058
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/04/2010