Provider First Line Business Practice Location Address:
501 WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 512
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-2231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-297-0014
Provider Business Practice Location Address Fax Number:
619-297-1014
Provider Enumeration Date:
12/10/2015