Provider First Line Business Practice Location Address:
3149 3RD 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:
92103-5613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-361-1989
Provider Business Practice Location Address Fax Number:
858-373-2148
Provider Enumeration Date:
08/27/2008