Provider First Line Business Practice Location Address:
4153B UNIVERSITY AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92105-1421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-693-5860
Provider Business Practice Location Address Fax Number:
619-693-5850
Provider Enumeration Date:
11/16/2016