Provider First Line Business Practice Location Address:
4029 43RD ST
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:
92105-1510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-284-3937
Provider Business Practice Location Address Fax Number:
619-284-3938
Provider Enumeration Date:
03/28/2012