Provider First Line Business Practice Location Address:
221 ISLAND 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:
92101-6936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-255-8855
Provider Business Practice Location Address Fax Number:
858-876-1944
Provider Enumeration Date:
06/07/2006