Provider First Line Business Practice Location Address:
4305 UNIVERISTY AVENUE
Provider Second Line Business Practice Location Address:
SUITE 150
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-966-5484
Provider Business Practice Location Address Fax Number:
858-966-5482
Provider Enumeration Date:
05/01/2012