Provider First Line Business Practice Location Address:
4118 W POINT LOMA BLVD
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:
92110-5605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-225-9354
Provider Business Practice Location Address Fax Number:
619-225-8365
Provider Enumeration Date:
10/21/2009