Provider First Line Business Practice Location Address:
5348 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:
92105-8025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-582-9056
Provider Business Practice Location Address Fax Number:
619-582-9057
Provider Enumeration Date:
05/16/2007