Provider First Line Business Practice Location Address:
2850 6TH AVE
Provider Second Line Business Practice Location Address:
STE #603
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:
619-295-5228
Provider Business Practice Location Address Fax Number:
619-295-5133
Provider Enumeration Date:
11/28/2006