Provider First Line Business Practice Location Address:
3505 CAMINO DEL RIO S
Provider Second Line Business Practice Location Address:
SUITE #305
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-4002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-280-3422
Provider Business Practice Location Address Fax Number:
619-280-3406
Provider Enumeration Date:
11/17/2007