Provider First Line Business Practice Location Address:
3500 5TH AVE
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-5053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-294-8459
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2006