Provider First Line Business Practice Location Address:
2280 GARNET AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92109-3775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-272-3717
Provider Business Practice Location Address Fax Number:
858-272-3737
Provider Enumeration Date:
10/27/2009