Provider First Line Business Practice Location Address:
700 W HARBOR DR
Provider Second Line Business Practice Location Address:
UNIT 1201
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92101-7753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-920-4543
Provider Business Practice Location Address Fax Number:
619-255-9500
Provider Enumeration Date:
10/11/2006