Provider First Line Business Practice Location Address:
427 C ST STE 216
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:
92101-5121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-239-4979
Provider Business Practice Location Address Fax Number:
619-239-5960
Provider Enumeration Date:
09/02/2006