Provider First Line Business Practice Location Address:
4282 GENESEE AVE
Provider Second Line Business Practice Location Address:
STE 302
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92117-4946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-450-1122
Provider Business Practice Location Address Fax Number:
858-571-3649
Provider Enumeration Date:
11/24/2006