Provider First Line Business Practice Location Address:
4840 1/2 PESCADERO 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:
92107-3415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-627-1789
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/13/2007