Provider First Line Business Practice Location Address:
446 26TH 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:
92102-3026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-531-7095
Provider Business Practice Location Address Fax Number:
619-531-8745
Provider Enumeration Date:
04/24/2007