Provider First Line Business Practice Location Address:
SDDMHS, 707 BROADWAY
Provider Second Line Business Practice Location Address:
SECOND FLOOR
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-410-1067
Provider Business Practice Location Address Fax Number:
619-533-6007
Provider Enumeration Date:
05/04/2007