Provider First Line Business Practice Location Address:
2948 UNIVERSITY 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:
92104-2934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-294-4500
Provider Business Practice Location Address Fax Number:
619-294-5753
Provider Enumeration Date:
01/10/2007