Provider First Line Business Practice Location Address:
4226 UNIVERSITY AVE
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:
92105-1503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-550-1555
Provider Business Practice Location Address Fax Number:
619-550-1888
Provider Enumeration Date:
10/21/2014