Provider First Line Business Practice Location Address:
2001 4TH AVEUNE
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:
92101-2303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-499-2704
Provider Business Practice Location Address Fax Number:
619-653-6111
Provider Enumeration Date:
06/12/2007