Provider First Line Business Practice Location Address:
4690 GENESEE AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92117-3000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-279-6100
Provider Business Practice Location Address Fax Number:
858-279-6112
Provider Enumeration Date:
08/09/2011