Provider First Line Business Practice Location Address:
3200 4TH AVE STE 101
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:
92103-5716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-928-5999
Provider Business Practice Location Address Fax Number:
619-937-2777
Provider Enumeration Date:
05/06/2008