Provider First Line Business Practice Location Address:
150 W WASHINGTON ST FL 2
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:
92103-2005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-543-4755
Provider Business Practice Location Address Fax Number:
619-543-1235
Provider Enumeration Date:
08/10/2009