Provider First Line Business Practice Location Address:
5500 CAMPANILE DRIVE
Provider Second Line Business Practice Location Address:
SAN DIEGO STATE UNIVERSITY, DEPARTMENT OF ENS
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92182-7251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-594-2017
Provider Business Practice Location Address Fax Number:
619-594-6553
Provider Enumeration Date:
08/23/2006