Provider First Line Business Practice Location Address:
2221 CAMINO DEL RIO S
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-3608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-454-2835
Provider Business Practice Location Address Fax Number:
619-220-0437
Provider Enumeration Date:
12/01/2006