Provider First Line Business Practice Location Address:
333 OLIVE ST
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:
92103-6215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-295-8002
Provider Business Practice Location Address Fax Number:
619-295-8098
Provider Enumeration Date:
11/21/2006