Provider First Line Business Practice Location Address:
818 SIXTH STREET
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:
92118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-488-3597
Provider Business Practice Location Address Fax Number:
858-746-4041
Provider Enumeration Date:
04/27/2012