Provider First Line Business Practice Location Address:
1281 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-7330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-339-9980
Provider Business Practice Location Address Fax Number:
610-298-7713
Provider Enumeration Date:
09/12/2007