Provider First Line Business Practice Location Address:
4448 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92105-1739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-603-9027
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/13/2006