Provider First Line Business Practice Location Address:
515 W WASHINGTON ST
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:
92103-1986
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-299-0079
Provider Business Practice Location Address Fax Number:
619-299-0762
Provider Enumeration Date:
02/10/2012