Provider First Line Business Practice Location Address:
3131 BERGER AVE
Provider Second Line Business Practice Location Address:
STE 250
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-4203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-277-1932
Provider Business Practice Location Address Fax Number:
858-492-1377
Provider Enumeration Date:
06/24/2005