Provider First Line Business Practice Location Address:
406 9TH AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92101-7276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-338-0911
Provider Business Practice Location Address Fax Number:
619-338-0933
Provider Enumeration Date:
03/16/2006