Provider First Line Business Practice Location Address:
2400 KETTNER BLVD
Provider Second Line Business Practice Location Address:
SUITE 221
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92101-1249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-231-4278
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2008