Provider First Line Business Practice Location Address:
3555 KENYON ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-446-1646
Provider Business Practice Location Address Fax Number:
858-636-2032
Provider Enumeration Date:
10/13/2010