Provider First Line Business Practice Location Address:
550 WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 601
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-2213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-260-7021
Provider Business Practice Location Address Fax Number:
619-260-7038
Provider Enumeration Date:
09/11/2007