Provider First Line Business Practice Location Address:
1230 COLUMBIA ST
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92101-8571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-232-4030
Provider Business Practice Location Address Fax Number:
619-232-4255
Provider Enumeration Date:
08/16/2006