Provider First Line Business Practice Location Address:
4475 UNIVERSITY AVE
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:
92105-1731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-269-4747
Provider Business Practice Location Address Fax Number:
619-269-4949
Provider Enumeration Date:
09/20/2007