Provider First Line Business Practice Location Address:
4033 3RD AVE
Provider Second Line Business Practice Location Address:
SUITE204
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-2117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-295-8677
Provider Business Practice Location Address Fax Number:
619-295-7935
Provider Enumeration Date:
02/10/2010