Provider First Line Business Practice Location Address:
9333 GENESEE AVE STE 170
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:
92121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-626-6261
Provider Business Practice Location Address Fax Number:
858-626-6271
Provider Enumeration Date:
07/13/2009