Provider First Line Business Practice Location Address:
4748 UNIVERSITY AVE STE D
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:
92105-1972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-640-8637
Provider Business Practice Location Address Fax Number:
619-640-8647
Provider Enumeration Date:
01/23/2007