Provider First Line Business Practice Location Address:
3500 - 5TH AVE
Provider Second Line Business Practice Location Address:
STE 106
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-294-8449
Provider Business Practice Location Address Fax Number:
619-294-2844
Provider Enumeration Date:
04/03/2009