Provider First Line Business Practice Location Address:
3750 SPORTS ARENA BLVD
Provider Second Line Business Practice Location Address:
SUITE 9
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92110-5129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-224-2879
Provider Business Practice Location Address Fax Number:
619-224-1311
Provider Enumeration Date:
08/16/2010