Provider First Line Business Practice Location Address:
4120 W POINT LOMA BLVD
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:
92110-5605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-297-2544
Provider Business Practice Location Address Fax Number:
619-297-2752
Provider Enumeration Date:
02/22/2008