Provider First Line Business Practice Location Address:
9339 GENESEE AVE
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-2119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-455-7520
Provider Business Practice Location Address Fax Number:
858-554-1312
Provider Enumeration Date:
10/01/2009