Provider First Line Business Practice Location Address:
4305 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SUITE 410
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92105-1645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-554-3185
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/15/2017