Provider First Line Business Practice Location Address:
4448 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92105-1739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-521-6798
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/02/2011