Provider First Line Business Practice Location Address:
3365 2ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-5611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-755-1988
Provider Business Practice Location Address Fax Number:
858-876-3044
Provider Enumeration Date:
02/17/2007