Provider First Line Business Practice Location Address:
1255 IMPERIAL AVE
Provider Second Line Business Practice Location Address:
SUITE 730
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-430-3021
Provider Business Practice Location Address Fax Number:
619-542-4060
Provider Enumeration Date:
09/21/2014