Provider First Line Business Practice Location Address:
1901 4TH AVE STE 200
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:
92101-8315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-540-9270
Provider Business Practice Location Address Fax Number:
619-684-3650
Provider Enumeration Date:
03/01/2010