Provider First Line Business Practice Location Address:
2727 CAMINO DEL RIO S
Provider Second Line Business Practice Location Address:
SUITE 224
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-3750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-993-4737
Provider Business Practice Location Address Fax Number:
619-578-2727
Provider Enumeration Date:
03/26/2009