Provider First Line Business Practice Location Address:
8650 GENESEE AVE
Provider Second Line Business Practice Location Address:
SUITE 314
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92122-1134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-622-9266
Provider Business Practice Location Address Fax Number:
858-622-0513
Provider Enumeration Date:
11/29/2012