Provider First Line Business Practice Location Address:
550 WASHINGTON ST
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-297-5437
Provider Business Practice Location Address Fax Number:
619-243-0722
Provider Enumeration Date:
02/29/2016