Provider First Line Business Practice Location Address:
1851 SAN DIEGO AVE
Provider Second Line Business Practice Location Address:
SUITE 100B
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92110-2168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-297-1519
Provider Business Practice Location Address Fax Number:
619-297-0705
Provider Enumeration Date:
02/09/2007