Provider First Line Business Practice Location Address:
3737 MORAGA AVE STE B109
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:
92117-5354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-270-2343
Provider Business Practice Location Address Fax Number:
858-270-1252
Provider Enumeration Date:
12/21/2011