Provider First Line Business Practice Location Address:
2420 ULRIC STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92111-6040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-467-9201
Provider Business Practice Location Address Fax Number:
858-467-0644
Provider Enumeration Date:
11/17/2006