Provider First Line Business Practice Location Address:
2220 5TH 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:
92101-2104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-491-9424
Provider Business Practice Location Address Fax Number:
619-230-1066
Provider Enumeration Date:
02/21/2007