Provider First Line Business Practice Location Address:
9333 GENESEE AVE
Provider Second Line Business Practice Location Address:
SUITE 170
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-882-8350
Provider Business Practice Location Address Fax Number:
858-882-8383
Provider Enumeration Date:
06/28/2007