Provider First Line Business Practice Location Address:
427 C ST STE 100
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:
92101-5113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-233-1666
Provider Business Practice Location Address Fax Number:
619-233-3724
Provider Enumeration Date:
07/02/2014