Provider First Line Business Practice Location Address:
2845 NIMITZ BLVD STE A
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:
92106-2387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-223-8179
Provider Business Practice Location Address Fax Number:
619-223-4736
Provider Enumeration Date:
10/24/2006