Provider First Line Business Practice Location Address:
3737 MORAGA AVE.
Provider Second Line Business Practice Location Address:
STE: B-414
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-272-5550
Provider Business Practice Location Address Fax Number:
858-272-5551
Provider Enumeration Date:
03/20/2007