Provider First Line Business Practice Location Address:
4282 GENESEE AVE STE 202
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:
92117-4989
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-284-0070
Provider Business Practice Location Address Fax Number:
858-284-0071
Provider Enumeration Date:
06/01/2007