Provider First Line Business Practice Location Address:
1515 PALM AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92154-1011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-429-4117
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2008