Provider First Line Business Practice Location Address:
2841 UNIVERSITY AVE
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:
92104-2928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-297-0446
Provider Business Practice Location Address Fax Number:
619-297-2628
Provider Enumeration Date:
01/14/2007