Provider First Line Business Practice Location Address:
4282 GENESEE AVE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92117-4946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-292-0108
Provider Business Practice Location Address Fax Number:
858-292-9097
Provider Enumeration Date:
01/23/2007