Provider First Line Business Practice Location Address:
330 LEWIS STREET
Provider Second Line Business Practice Location Address:
MAIL CODE 8201-A
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-8201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-471-9250
Provider Business Practice Location Address Fax Number:
619-471-9255
Provider Enumeration Date:
01/05/2007