Provider First Line Business Practice Location Address:
1060 UNIVERSITY AVE # A201
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:
92103-3310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-543-0112
Provider Business Practice Location Address Fax Number:
619-543-0094
Provider Enumeration Date:
11/08/2006