Provider First Line Business Practice Location Address:
1452 UNIVERSITY AV
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-291-5433
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2017