Provider First Line Business Practice Location Address:
1281 UNIVERSITY AVE STE C
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:
92103-7305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-800-5097
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/19/2017