Provider First Line Business Practice Location Address:
5275 MARKET ST STE E
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:
92114-2212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-952-2749
Provider Business Practice Location Address Fax Number:
619-264-0206
Provider Enumeration Date:
10/25/2012