Provider First Line Business Practice Location Address: 
770 WASHINGTON ST
    Provider Second Line Business Practice Location Address: 
#207
    Provider Business Practice Location Address City Name: 
SAN DIEGO
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
92103-2209
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
619-299-5000
    Provider Business Practice Location Address Fax Number: 
619-299-1549
    Provider Enumeration Date: 
02/14/2007