Provider First Line Business Practice Location Address:
4448 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92105-1739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-521-6799
Provider Business Practice Location Address Fax Number:
619-521-6799
Provider Enumeration Date:
07/29/2005