Provider First Line Business Practice Location Address:
4033 3RD AVE
Provider Second Line Business Practice Location Address:
SUITE 300
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:
619-299-2570
Provider Business Practice Location Address Fax Number:
619-299-1834
Provider Enumeration Date:
05/11/2007