Provider First Line Business Practice Location Address:
4844 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SUIT B
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92105-8021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-285-5010
Provider Business Practice Location Address Fax Number:
619-285-5013
Provider Enumeration Date:
05/25/2007